Skip to main content

Full text of "Practical hydrotherapy, a manual for students and practitioners"

See other formats


PRACTICAL 

HYDROTHERAPY 

A MANUAL 

For Students and Practitioners 



BY 

CURRAN POPE, M.D. 

Professor of Physio-Therapy, University of Louisville Medical Department; Ex-Professor of 
Physio-Therapy in the Kentucky School of Medicine, Louisville, Ky.; State Secretary 
American Physio-Therapeutic Association; President American Physio-Therapeutic Asso- 
ciation; Ex-President Louisville Neurological Society; President Ohio Valley Medical 
Association; Consulting Neurologist to the Louisville City Hospital; Formerly Resi- 
dent Physician to the Lakeland Hospital for the Insane; Ex-Professor of Diseases 
of the Mind and Nervous System, Electro-Therapy, Hydrotherapy, etc., in the 
Louisville Medical College; Ex-Professor of Pathology, Histology and Bacteri- 
ology, Hospital College of Medicine; Member American Medical Associa- 
tion; American Electro-Therapeutic Association; American Roentgen Ray 
Association; Mississippi Valley Medical Association; Kentucky State 
Medical Association; Jefferson County Medical Society; Louisville 
Academy of Medicine; American Medical Editors' Association ; 
President Louisville Society of Medicine and Surgery; Ex-Presi- 
dent Louisville Medical and Surgical Society; Member Inter- 
national Physio-Therapeutic Congress, Rome, Italy ; Member 
Society for the Advancement of Science; Associate Editor 
Journal of Advanced Therapeutics; Associate Editor 
Central States Medical Monitor; Associate Editor 
Kentucky Medical Journal, and Medical Super- 
intendent of the Pope Sanatorium, Louisville, Ky. 



CINCINNATI 

CINCINNATI MEDICAL BOOK COMPANY 
1909 



Copyrighted, 1909, by 
Cukkan Pope, Louisville, Kv. 







The Lancet-Clinic Publishing Co., 
Cincinnati, O. 



THIS BOOK IS DEDICATED 
TO THE MEMORY OF 

MY FATHER AND MOTHER 

AS A SLIGHT TOKEN OF THE 

DEEP LOVE AND RESPECT OF THEIR SON 

THE AUTHOR 



PREFACE. 

The author offers no apology for another work upon hydrotherapy, 
as there are at present very few works in the English language. 

It cannot be denied that much prejudice has heretofore existed 
against "baths" owing to their purely empirical application, but with 
the advent of instruments of precision and the establishment of their 
physiological action, scientific hydrotherapy has taken its place among 
the accepted therapeutic methods of medicine. 

It has seemed strange at times why the brilliant clinicians of this 
country have failed to use hydrotherapy as a curative agent, but of late 
years this cannot be said save in certain quarters, for the profession is 
rapidly awakening to the broad field of usefulness possessed by this 
agent. 

The plan adopted has been to ascertain all the facts possible, no 
matter from what source, the writer's experience then added, and from 
the data thus obtained, the different chapters have been written. The 
aim has been to simplify hydrotherapy and to so plainly and clearly 
lay before the reader the essential facts as to render them easy of 
mastery, accessible and useful. 

The hydriatist's art has not been magnified nor has the author in- 
dulged in a minute and endless subdivision of baths, both general and 
local, each with their physiological and therapeutic action separate, but 
has as far as is possible grouped together those procedures whose tech- 
nique, physiological action and therapy closely resemble one another, 
thus enabling the student to master the action of "groups" rather than 
each separate form. 

To the student or practitioner who may desire to systematically 
acquire a knowledge of hydrotherapy, due warning is given that there 
is no royal road to knowledge, and that this is true of hydrotherapy as 
well as of all the other departments of science. However, a certain 
line of procedure may aid in more easily mastering the art. It would 
not be amiss to cursorily refresh his general knowledge of the anatomy 
of the nervous system, of the blood and lymph circulations. He should 
then carefully ground himself in the physiological action of water 
and its associated applications, such as hot air, electric light baths, etc. 
A mastery of the general principles of hydrotherapy, its rules and 
regulations, will make the technique more easy of comprehension and 
its rationale apparent. 

Much information and a clearer insight than mere description can 
give, is to note the physiological action of hydrotherapy by "putting 
yourself in his place." One application of a cold jet douche to the 



vi PREFACE. 

spine gives more realistic information than pages of description. I 
therefore make the suggestion to "practice on yourself" first. Many 
experiments herein mentioned have had the author as principal party 
in interest. 

It should never be forgotten that physiological forces so powerful 
for good may equally work havoc if carelessly and improperly applied. 
Therefore utility and exactitude of method have been the constant aim. 

In the therapeutic section rare diseases have not been considered 
unless water possesses some curative value in that particular disease. 
Theories have been avoided as they generally prove a burden and in- 
terfere with a clear comprehension of the agent. Physicians nor rem- 
edies possess healing powers, but the curative process, as is well 
known, resides within the body, and it is the body that heals itself. I 
believe that water is an agent more capable of developing natural heal- 
ing powers in the system and in resisting the onset, development and 
extension of disease, than any other known single measure. 

Some will doubtless think that the chapters dealing with nervous 
and mental diseases, drug habits and alcoholism have been needlessly 
enlarged. The nihilism of therapeutics that pervades these branches, 
the neglect of a remedial measure so powerful for betterment and 
"cure," has led to a broad and full consideration of these subjects, with 
the hope that specialists in these various fields of the therapeutic art 
may be induced to use this remedy more extensively than is the case 
at present. 

A careful perusal will show that hydrotherapy offers an extensive 
and useful field to the practitioner in acute and subacute conditions, 
for there are many cases, especially of acute diseases, that could be 
treated at home by the family physician with success, and it is be- 
lieved that a careful study of the possibilities of hydrotherapy will 
convince many medical men who do not now use hydriatics, that it is 
a valuable addition and supplement to their other efforts. Chronic 
cases are best treated in sanatoria because of the facilities, the experi- 
ence, skill and knowledge required by the physician in charge, assisted 
by a well-trained staff. 

Twenty years as teacher of students and nurses, twenty years at the 
head of a sanatorium, in active hospital and private practice, has con- 
stituted an experience upon which the author has freely drawn. 

Thanks are due to the publishers for their uniform courtesy, kind 
consideration and willingness to make this book represent the author's 
views. 

The Author. 
Louisville, Ky., September, 1909. 



CONTENTS. 

CHAPTER 1. 

HISTORY OF HYDROTHERAPY. 

Of Great Antiquity — Used by Ancient Hindoos, Persians, Egyptians, etc. 
— Hydrotherapy in Greece — Its Use by Hippocrates — the Japanese — 
Use in Early Days of Roman Empire — Thermae of Rome and Pompeii 
— The Baths of Caracalla — Galen — Ambroise Pare — James Currie— 
Early Use in Various Diseases — Vincent Priessnitz — His History — 
Early Impression and Use of Hydrotherapy — His Organization and 
Systematic Treatment, Local and General — Fleury's Visit to Priessnitz 
— -His Later Adoption of Hydrotherapy and Origination of the Douche 
— Brand and His Baths in Typhoid — -John Chapman and His Spinal 
Ice Bag — The Birth of Scientific Hydrotherapy — Wm. Winternitz and 
His Scientific Work and Discoveries — The Basis of Modern Hydro- 
therapy — Simon Baruch and J. H. Kellogg's Work 1-10 

CHAPTER II. 

GENERAL CONSIDERATION- ANATOMY AND PHYSIOLOGY OF 

THE SKIN. 

Definition — Physical Properties of Water — Thermic Action — Mechanical 
Effects — Adaptability — Cleansing, Antiseptic Action — Anatomy of the 
Skin — Physiology of the Skin 11-20 

CHAPTER III. 

PHYSIOLOGICAL ACTION OF WATER EXTERNALLY APPLIED. 

Classification of Temperatures — Physiological Action of Water on Tempera- 
ture — Of Heat on Temperature — Of Cold on Temperature — Physio- 
logical Action Upon the Circulation — Action of Heat Upon the Circula- 
tion — Of Cold Upon the Circulation — Physiological Action Upon Res- 
piration — Action of Heat Upon Respiration — Of Cold Upon Respira- 
tion — Physiological Action Upon Metabolism — Means by Which it is 
Influenced— Effect Upon Secretion — Upon Absorption — Upon Tissue 
Change — Upon Excretion — Physiological Action Upon the Nervous Sys- 
tem — Action of Heat Upon the Nervous System — Action of Cold Upon 
the Nervous System — Physiological Action Upon the Muscular System 
— The Action of Heat Upon the Muscular System — Of Cold Upon the 
Muscular System — Physiological Action Upon the Blood — The Action 
of Heat Upon the Blood — Of Cold Upon the Blood — Hydrotherapeutic 
Reaction of Heat — Of Cold — Contraindications 21-53 

CHAPTER IV. 

THE INTERNAL USES OF WATER. 

The Supposed Mystical Power of Springs and Spas — The Necessity of 
Water — Need of Careful Prescribing — Benefits from Water Itself — 
Rarely from Mineral Contents — Action on the Body — Physiological 
Action of Water — Therapeutics 54-61 



viii COX TEXTS. 

CHAPTER V. 
ASSOCIATED PROCEDURES. 

Sun Light — Physiological Action of Light — Therapeutic Application — In- 
candescent Electric Light Bath — Physiological Action — The Arc Light 
Bath — Technique — Therapeutic Application — Hot Air Cabinet — Turkish 
Bath — Vapor Cabinet — Russian Bath — Superheated Dry Hot Air — Phy- 
siological Action of Heat by Conduction — Therapeutics 64-84 

CHAPTER VI. 
MINOR HYDROTHERAPEUT1C METHODS. 

Local Heat and Cold — Chapman's Methods ; Hot Water and Ice Bags — Fric- 
tion—Sand Bath— Salt Rub— Oil Rub— Electric Bath— Steam 85-94 

CHAPTER VII. 

RULES, REGULATIONS AND PRACTICAL SUGGESTIONS 95-106 

CHAPTER VIII. 

EQUIPMENT OF HYDROTHERAPEUTIC INSTITUTIONS AND 
SANATORIA 107-113 

CHAPTER IX. 

THE TECHNIQUE OF HYDROTHERAPY. 

The Author's Clinical Division of Baths — Sponge or Towel Bath ; Ablution 
— The Dripping Sheet or Sheet Bath — The Fomentation — Compresses 
— Cold and Cooling, Their Therapeutics — Stimulating Compress — Phy- 
siological Action — Therapeutics — Hot Compress — Physiological Action — 
Therapeutics — The Cephalic Compress— The Throat Compress — The 
Chest Compress — The Trunk Compress — The Joint Compress — The 
Wet Pack — Its Physiologic Action — Therapeutics — The Half Wet Pack 
The Hot Blanket Pack— The Dry Full Pack— Local Baths— Hot Foot 
Bath— Cold Foot Bath— Sitz Baths— The Cold Sitz Bath— The Hot Sitz 
Bath— The Half Bath 114-149 

CHAPTER X. 

THE TECHNIQUE OF HYDROTHERAPY (Continued). 

The Very Hot and Hot Full Bath— The Warm Full Bath— The Cleansing 
Bath — Bathing of the Infant— The Neutral Bath — The Continuous Bath 
— Nauheim or Effervescent Bath — The Cold Full Bath — The Cold 
Sponge Bath — Surf Bathing — Mineral Baths — Douches — Affusions — 
Shower Bath — Circular, Horizontal Rain, Needle or Spray Bath— Jet 
Douche — Fan Douche — Perineal Douche — the Scottish or Alternate 
Douche — Physiological Action of Hot Douches — Therapeutics — Physi- 
ological Action of Cold Douches — Therapeutics 150-193 

CHAPTER XI. 

SPECIAL THERAPEUTICS: FEVERS. 

Simple Fevers — Typhoid Fever — La Grippe : Influenza — Malarial Fevers — 
Measles — Chicken Pox — Whooping Cough — Scarlet Fever — Diphtheria — 
Mumps — Erysipelas — Cerebro-Spinal Meningitis — Smallpox — Yellow Fe- 
ver — Cholera — Cholera Nostras — Typhus Fever — Montana Spotted 
Fever 194-232 



CONTENTS. ix 

CHAPTER XII. 

DISEASES OF THE STOMACH AND INTESTINAL TRACT. 

Acute Gastritis — Chronic Gastritis — Gastric Atony ; Dilatation — Intestinal 
Atony — Splanchnoptosis — States of Hypersecretion : Hyperchlorhydria, 
Hyperchylia, Reichmann's Disease, Chronic Sthenic Gastritis — Gastric 
Ulcers — Duodenal Ulcers — States of Hyposecretion : Hypochlohydria, 
Achlohydria, Anacidity. Hypochylia, Achylia Gastrica, Hypopepsia, 
Apepsia — Acute Intestinal Catarrh — Acute Enteritis — Acute Entero-Co- 
Htis — Acute Gastro-Entero-Colitis of Children — Cholera Infantum — 
Summer Diarrhea— Summer Complaint — Acute Diarrhea — Acute Dys- 
entery — "Bloody Flux" — Acute Colitis — Acute Proctitis — Chronic En- 
teritis — Chronic Entero-Colitis — Chronic Intestinal Catarrh — Chronic 
Diarrhea — Chronic Dysentery — Chronic Colitis — Chronic Proctitis — 
Constipation — Neuroses of the Stomach and Intestines — Gastralgia — 
Gastric Hyperesthesia — Derangements of Appetite — Anorexia — Hyper- 
koria — Boulimia — Akoria — Polyphagia — Parorexia— The Motor Neuro- 
ses — Gastrospasm — Cardiospasm — Pylorospasm — Hyperistalsis — Ner- 
vous Vomiting — Rumination — Mercyism — Regurgitation — Enteralgia — 
Intestinal Colic — Meteorism — Tympanites — Peristaltic Unrest 233-252 

CHAPTER XIII. 

DISEASES 'OF THE NASO-PHARYNX, LARYNX AND CHEST. 

Acute Rhinitis — Acute Pharyngitis — Acute Tonsillitis — Acute Laryngitis and 
the Treatment of Post-Operative Inflammations — Chronic Rhinitis — 
Chronic Pharyngitis — "Clergyman's Sore Throat" — Chronic Tonsillitis 
— Chronic Laryngitis — Croupous Laryngitis — Spasmodic Laryngitis — Lar- 
ingismus Stridulus — Acute Bronchitis — Capillary Bronchitis — Chronic 
Bronchitis — Fibrinous Bronchitis — Pulmonary Congestion — Pulmonary 
Edema — Hemoptysis — Pulmonary Hemorrhage — Lobar Pneumonia — Ca- 
tarrhal Pneumonia — Asthma — Hay Fever — Hay Asthma — Emphysema — 
Tuberculosis — Prophylaxis — Prevention of Acute and Chronic Respira- 
tory Inflammations — Pleuritis 253-279 

CHAPTER XIV. 

DISEASES OF THE PERITONEUM; LIVER; RHEUMATISM; GOUT; 
DIABETES ; OBESITY ; RACHITIS. 

Peritonitis — Ascites — Dropsy — Anasarca — Hepatic Congestion — Catarrhal 
Jaundice — Cholelithiasis — Acute Infectious Cholecystitis — Cholangitis — 
Hepatic Cirrhosis — Acute Articular Rheumatism — Chronic Articular 
Rheumatism — Muscular Rheumatism — Rheumatoid Arthritis — Gout — 
Lithemia — Uric Acid Diathesis — Diabetes Mellitus — Diabetes Insipidus — 
Obesity — Rachitis 280-305 

CHAPTER XV. 

DISEASES OF THE KIDNEY AND BLOOD. 

Renal Hyperemia — Acute Nephritis — Chronic Nephritis — Chronic Parenchy- 
matous and Chronic Interstitial Nephritis — Uremia — Nephroptosis— 
Floating Kidney — Renal Colic — Anemia — Chlorosis — Pernicious Anemia 
— Splenic Anemia — Leukocythemia — Hodgkins' Disease 306-315 



x COX TEXTS. 

CHAPTER XVI. 
DISEASES OF THE HEART AND BLOOD-VESSELS. 

Pericarditis — Endocarditis — Myocarditis — The Treatment of Chronic Or- 
ganic Disease of the Heart and Blood-vessels — Schott Resistive Gym- 
nastics — Oertel's system — Chronic Cardiac Disease : Organic Valvular 
Heart Disease, Mitral Regurgitation, Aortic Regurgitation, Tricuspid 
Regurgitation. Pulmonic Regurgitation, Mitral Stenosis, Aortic Stenosis, 
Tricuspid Stenosis, Pulmonic Stenosis, Chronic Myocarditis — Cardiac 
Dilatation — Cardiac Hypertrophy — Fatty Heart — Arterio-Sclerosis : Hy- 
pertension — Angina Pectoris — Functional Heart Disease : Cardiac Neu- 
roses, Cardiac Collapse, Neurasthenic or Weak Heart, Palpitation, 
Brachycardia, Tachycardia, Arhythmia 316-335 

CHAPTER XVII. 

DISEASES OF THE PERIPHERAL NERVES, BRAIN AND 
SPINAL CORD. 

Neuritis — Facial Palsy — Sciatic Neuritis — Sciatica — Multiple Neuritis — Neu- 
ralgia — Intercostal Neuralgia — Tic Douloureux — Meningitis — Cerebral 
Pachymeningitis — Acute Leptomeningitis — Tubercular Meningitis — 
Spinal Pachymeningitis — Spinal Meningitis — Cerebral Hemorrhage — 
Cerebral Apoplexy — Cerebral Thrombosis — Cerebral Embolism — Acute 
Myelitis — Acute Poliomyelitis — Polioencephalitis Superior — Landry's Par- 
alysis — Acute Bulbar Paralysis — The Caisson Disease — Chronic Myelitis 
— Chronic Stage of Poliomyelitis — Chronic Stage of Acute Myelitis — 
Chronic Degenerative Spinal Diseases — Spastic Spinal Sclerosis or "Lat- 
eral Sclerosis" — Combined Spinal Scleroses — Ataxic Paraplegia — Mul- 
tiple or Disseminated Sclerosis — Hereditary Spinal Ataxia or Fried- 
reich's Ataxia — Amyotrophic Lateral Sclerosis — Chronic Muscular 
Atrophies 336-360 

CHAPTER XVTII. 

FUNCTIONAL NERVOUS DISEASES. 

Neurasthenia — Spinal Irritation — Nervous Dyspepsia — Hysteria — Epilepsy — 
— Chorea — Exophthalmic Goitre — Headache — Migraine — Insomnia — Ver- 
tigo — Tinnitus Aurii — Tinnitus Cerebri — Sea Sickness — Occupation Neu- 
rosis — Professional Neurosis — Fatigue Neurosis — Writers' and Other 
"Cramps" — Paralysis Agitans — Parkinson's Disease — Shaking Palsy — 
Facial Spasm — Mimic Tic — Spasmodic Torticollis — Wry Neck — Spas- 
modic Tics — Habit Spasm — Insolation — Sunstroke — Heatstroke — Ther- 
mic Fever — Cerebral Hyperemia 361-414 

CHAPTER XIX. 

MENTAL DISEASES. 

Mania — Melancholia — Confusional Insanity — Paranoia — Chronic Delusional 
Insanity — Monomania — Folie Raisonnante — Primare Verruechtheit — De- 
mentia Precox — Paresis 415-434 

CHAPTER XX. 

DRUG HABITS. 

Morphine — Cocaine — Chloral — Cannabis Indica — Tobacco Habit — Coffee — 
Tea 435-456 



CONTENTS. xi 

CHAPTER XXI. 

ALCOHOLISM. 

Acute Alcoholic Intoxication (Drunkenness) — Acute Alcoholic Mania 
(Mania a Potu) — Acute Alcoholic Delirium (Delirium Tremens) — 
Chronic Alcoholism — Chronic Drunkenness and Inebriety — Pathological 
Anatomy — Treatment — Prophylaxis of Alcoholism 457-498 

CHAPTER XXII. 

REARING THE DELICATE, TUBERCULAR AND NEUROPATHIC 
CHILD 499-504 

CHAPTER XXIII. 
DISEASES OF WOMEN. 

Vulvitis — Pruritus Vulva? — Vaginismus and Vulvo-Vaginal Hyperesthesia — 
Vaginitis — Amenorrhea — Dysmenorrhea — Endometritis — Metritis — 
Chronic Endometritis — Chronic Metritis — Uterine Displacements — Uter- 
ine Hemorrhage — Menorrhagia and Metrorrhagia — Abortion — Eclampsia 
— Salpingitis — Acute Oophoritis — Chronic Oophoritis — Pelvic Cellulitis 
and Pelvic Peritonitis — Pelvic Pain and Pelvic Congestion — Sterility — 
Menopause — Treatment 505-532 

CHAPTER XXIV. 

GENITO-URINARY DISEASES AND SYPHILIS. DISEASES OF THE 

RECTUM. 

Urethritis — Gonorrhea — Epididymitis — Orchitis — Prostatitis, Acute and 
Chronic — Spermatorrhea — Sexual Neurasthenia — Impotence — Priapism — 
Neuroses and Neuralgia — Syphilis — Lues — Pox — Cachexia — Mercnrialism 
— Suppression of Urine — Cystitis — Irritable Bladder — Atony of the Blad- 
der — Enuresis — Enuresis Nocturna — Retention of Urine — Fissure of the 
Anus and Irritable Ulcer of the Rectum — Sphincterismus — Rectal Pro- 
lapse — Hemorrhoids 533-554 

CHAPTER XXV. 

DISEASES OF THE SKIN, EYE AND EAR. 

Urticaria — Eczema — Pemphigus — Herpes Simplex — Herpes Zoster — Acne 
— Psoriasis — Dermatitis — Burns — Furuncle — Carbuncles — Comedo — 
Milium — Alopecia — Alopecia Areata — Hyperidrosis — Anidrosis — Sudam- 
ina — Miliaria — Seborrhea — Pruritus — Bed Sores — Cold Hands and Feet 
— Leprosy — Skin Diseases in General — Eye and Ear 555-579 

CHAPTER XXVI. 

HYDROTHERAPY IN SURGERY. 

Contusions — Sprains — Dislocations — Fractures — Spinal Curvature — Angular 
Curvature of the Spine — Pott's Disease — Spondylitis — Caries — Surgical 
Shock — Hemorrhage — Surgical Fever — Abdominal Surgery — Synovitis, 
Acute and Chronic — Arthritis — Exudates in Joints — Adhesions of Joints 
— Contractures of the Joints — Ankylosis — Ulcer — Gangrene — Septic In- 
fection — Osteitis — Periostitis — Osteoperiostitis — Osteomyelitis — Appen- 
dicitis 580-598 



LIST OF ILLUSTRATIONS. 

PLATE PAGE 

1 — Baths of Caracalla 2 

2— Strigilli 2 

3 — Farnese Statuary : Hercules, Bull, Faun 4 

4 — Hydrotherapeutic Masters 6 

5— The Early Methods of Piressnitz (Kellogg) 8 

6 — The Early Methods of Priessnitz ( Kellogg ) 10 

7 — The Early Methods of Priessnitz (Kellogg) 10 

8 — Microscopic Section of Skin 14 

9 — Microscopic Section of Skin Injected, Showing Skin Circulation 14 

10 — Microscopic Section of Skin, Showing Sebaceous Glands 16 

11 — Microscopic Section of Skin, Showing Glandular Structures 16 

12 — Normal Fatigue Curve of Man, Aged Twenty-four Years (Kellogg).. 44 

13 — Fatigue Curve of the Same Subject After a Hot Bath (Kellogg) 44 

14 — Normal Fatigue Curve 46 

IS — Open Air Gymnasium (Kellogg) 64 

16 — Open Air Gymnasium (Kellogg) 64 

16a — Indoor Sun Bath (Kellogg) 62 

17 — Incandescent Electric Light Bath 66 

18 — Incandescent Electric Light Bath, Horizontal 66 

19— Incandescent Electric Light Bath, Horizontal (Kellogg) 68 

20— Incandescent Electric Light Bath, Closed (Mott) 70 

21— Incandescent Electric Light Bath, Open (Mott) 70 

22 — Local Incandescent Electric Light Baths (Kellogg) 70 

23 — Light and Arc Cabinet Combined, Open (Monell) 72 

24 — Light and Arc Cabinet Combined, Closed ( Monell ) 72 

25 — Superheated Dry Hot Air, Body Apparatus ; Sliding Table Tilted to 

Show Openings 74 

26 — Superheated Dry Hot Air, Body Apparatus; Ready for Patient 76 

27 — Superheated Dry Hot Air, Body Apparatus ; Patient in Position to be 

Slid Into Cylinder 78 

28 — Superheated Dry Hot Air, Body Apparatus ; Patient Taking Treatment. 78 
39 — Superheated Dry Hot Air ; Local Application : Foot Bandaged in Turk- 
ish Toweling Ready to be Introduced 80 

30— Superheated Dry Hot Air ; Treating Foot 80 

31 — Superheated Dry Hot Air ; Treating Hand and Arm SO 

32 — Superheated Dry Hot Air ; Treating Knee with Special Apparatus for 

this Joint 80 

33— Superheated Dry Hot Air ; Treating Hip 82 

34 — Superheated Dry Hot Air ; Treating Back 82 

35— Hot Air Cabinet 84 

36— Hot Air Cabinet in Use 84 

37 — Chapman's Spinal Ice Bags ; Chapman's Double Column Spinal Hot 

Water Bag ; Ordinary Hot Water Bottle 86 

38— Friction with Flesh Brush 88 

39— Salt Rub or Glow 90 

40— Author's Plan 108 

40a— Diagram of Hydriatic Room ( Mott ) 108 

xiii 



xiv LIST OF ILLUSTRATIONS. 

PLATE PAGE 

41 — Water Cooling Device 112 

42 — Tobey's Automatic Water Heater; Soap Dish; Towel Rack (Mott) HO 

43 — Bath Room Accessories ; Pitcher ; Salt Jar ; Thermometer ; Fibre 

Bucket; Bath Room Floor Slats 110 

44 — Ice Cap or Helmet ; Steam Kettle 112 

45 — Sponge or Towel Bath 1 14 

46 — Alternate Hot and Cold Sponge to Spine 116 

47 — Dripping Sheet — Ready 118 

48 — Dripping Sheet — First Stage HS 

49 — Dripping Sheet — Second Stage 118 

SO — Dripping Sheet — Completed 1 18 

51 — The Fomentation — Ready 120 

52 — The Fomentation — Pouring the Boiling Water 120 

53 — The Fomentation — Removing Water with Wringer 122 

54 — The Fomentation — Removing Water by Using a Twisted Towel 122 

55 — The Fomentation — In Position 122 

56 — The Fomentation — Completed 122 

57 — Stimulating Compress — Compress in Position 124 

58 — Stimulating Compress — Completed 124 

59— Coil Cap to Head 124 

60 — Precordial Compress and Ice Bag — The "Hydrotherapeutic Digitalis".. 124 

61— Chest Compresses 128 

62 — Chest Compress — First Stage 128 

63 — Chest Compress — Second Stage 128 

64 — Chest Compress — Completed 128 

65 — Permanent Throat Bandage 126 

66 — Joint Compress 126 

67 — Throat Compress 126 

68— Pelvic Pack— Ready 130 

69— Pelvic Pack— First Stage 130 

70— Pelvic Pack— Second Stage 130 

71— Pelvic Pack— Completed 130 

72— Full Wet Pack— First Stage 132 

73— Full Wet Pack— Second Stage 132 

74— Full Wet Pack— Third Stage 132 

75— Full Wet Pack— Fourth Stage 132 

76— Full Wet Pack— Fifth Stage 134 

77— Full Wet Pack— Sixth Stage 134 

78— Full Wet Pack— Seventh Stage 134 

79— Full Wet Pack— Completed 134 

80— Half Wet Pack 136 

81— Hot Blanket Pack 136 

82— Foot Bath 140 

83— Sitz or Hip Bath Tubs 142 

84 — Sitz or Hip Bath 142 

85— Half Bath 146 

86 — Affusion to Back and Spine 146 

87 — The Continuous Bath 156 

88— The Continuous Bath 1 58 

88a — The Continuous Bath 160 

89- — Continuous Bath, or Bathing at Leukebad, Switzerland 162 

90 — Diagram of Cardiac Area of Dullness Before and After Nauheim Bath. 164 

91— Portable Bath Tubs 166 



LIST OF ILLUSTRATIONS. xv 

PLATE PACE 

92— Patient in Deflated Tub 168 

93— Inflating the Tub 168 

94 — Nurse Applying Friction 170 

95— Drawing Off the Water 170 

96— Drying Patient 172 

97— Removing Tub 172 

97a— Plunge Tub 174 

98— The Surf— Nature's Douche 176 

99— Surf Bathing 178 

100 — Coliseum Swimming Pool, Louisville,- Ky 178 

101 — Author's Douche Apparatus 180 

102— Douche Table 182 

103— Douche Table (Baruch) 182 

104— Hydriatic Room 182 

105— Shower Baths 184 

106 — Affusion to Chest 184 

107 — Circular, Horizontal, Rain or Needle Bath 184 

108 — Perineal Douche Apparatus 186 

109— Perineal Douche 186 

110 — To Show Compact Arrangement of Horizontal Rain or Needle Bath, 

Triangle, Perineal Douche and Shower Bath 188 

111— Fan Douche 188 

1 12 — Fan Douche to Spine 188 

1 13— Jet Douche 190 

1 14 — Jet Douche to Spine 190 

1 15 — Scottish or Alternate Douche 190 

1 16 — Scottish or Alternate Douche to Spine 190 

1 17— Shower Bath 192 

118— Portable Bath Tub (Mott) 198 

119— Brand Bath— First Stage (Cohen's "Physiological Therapeutics") 200 

120— Brand Bath— Second Stage (Cohen's "Physiological Therapeutics")... 200 

121— Brand Bath— Third Stage (Cohen's "Physiological Therapeutics") 202 

122— Brand Bath— Fourth Stage (Cohen's "Physiological Therapeutics") ... 202 

123— Tent Village, Fort Stanton, N. M. (Carrington) 270 

124— "Easy Street," Fort Stanton, N. M. (Carrington) 272 

125— A Row of Six Tent Houses, Fort Stanton, N. M. (Carrington) 274 



PRACTICAL HYDROTHERAPY. 



CHAPTER I. 
HISTORY OF HYDROTHERAPY. 

Hydrotherapy had its birth in the mists of antiquity, for bathing 
is probably as old as the hills themselves. From the most ancient 
of times water has been used as an agent in the treatment of dis- 
ease, probably because it is so universally found, is easy of applica- 
tion, and because of the relief which has been so frequently obtained 
by its use. The ancient Hindus, Persians, Hebrews, Egyptians and 
Greeks, all employed water in the treatment of various diseases, and 
in the Yedas of Susrotas water is often spoken of as an article of 
treatment and as an antidote, the number and time of the bath being 
exactly regulated. That they attached importance to the subject is 
shown by the minuteness of detail which is given. The Magi of 
the Persians and Chaldeans utilized water in their therapeutic prac- 
tice, and, as we read of holy wells in the neighborhood of their tem- 
ples, it certainly played no unimportant role. The ancient Egyp- 
tians worshiped the Nile, as the Hindus did the Ganges, and they 
thought that bathing in its waters served to produce fertility alike 
in the land and in sterile women. 

It was in Greece that water first reached its highest repute; and 
here Homer sings of bathing; Hector, wounded, finds recovery by 
means of water. In the midst of groves near springs, temples were 
erected in honor of Asklepios, the Greek god of the healing art; they 
were always located in airy, sheltered, healthy places, and were pro- 
totypes of the modern sanatorium. They were distinguished from 
other temples by their simplicity and spaciousness. The temple 
proper was usually very small, containing merely the statue of Asklep- 
ios, sometimes accompanied by his daughter Hygeia. This was sur- 
rounded by open colonnades where the suppliants gathered. There 
was always a sacred spring at the entrance to the temple. As the 
god was said to have been born in Epidaurus, the temple there was 
the most extensive of all. The walls were lined with bas reliefs, some 
still well preserved, portraying the return to health, or gratitude for 
recovery, of the flocking pilgrims, or of entire cities. The temple 
contained also statues of the healed persons, or of the healed part 



2 PRACTICAL HYDROTHERAPY. 

of the body, statues of the head, hand, foot, breasts, shoulder, hip, 
etc., classified as to groups, which must have given the temple the 
appearance of a pathologic museum. Other votive offerings, urns, 
vases, seats, filled some of the rooms, and hung from the ceilings, 
some of them costly gold and silver articles set with jewels, which 
were despoiled later by the Roman conquerors ; the temple is now an 
empty ruin. The priests who had charge of these temples acquired 
a certain insight into the medical sciences in time, and were able to 
cure many of the applicants. They refused to admit persons with 
contagious diseases, or in an advanced stage of any disease, and it 
was forbidden to deliver a woman even in the environment of a 
temple. Aristophanes gives a graphic description of the application 
of a sick person for relief. He first had to bathe in the sacred 
spring, and then make an offering to the god. Each party had to 
supply his own wants, as the temple offered nothing but a bed of 
dried leaves under the colonnade. The priests, as darkness approached, 
went through a certain ritual to impress the patients with a sense of 
mystery and of the nearness of the god. The priests advised cer- 
tain gymnastics, riding, hunting, and similar sports ; in others, cheer- 
ing music, singing, etc., hydrotherapy, including running barefoot 
in the grass, and numerous hygienic and therapeutic measures. Thus 
it was that mystical methods of prayer, and cleansing, and strict 
fasting, prepared the devotee for the application of the cold water 
cure. Here it was that Hippocrates, 1 the father of systematic medi- 
cine, was first fired with enthusiasm by a perusal of the votive tablets, 
and undertook the study of this agent with a view to its systematic 
use for medical treatment. Hippocrates belonged to the tribe of the 
priests of Asklepios, but emancipated himself from its methods 
and teachings. "He was the first to maintain that cold water 
warms, while warm water cools the body. He was acquainted 
with the shower bath and shampooing, and showers to induce sleep. 
Cold water poured over the body he found useful in fainting. He 
treated tetanus with showers, and in affections of the joints he recom- 
mends the pouring over of cold water as being useful in relieving 
the pain and curing the affection. . . . Elevation of temperature 
was known to him as a symptom of fever, and he recommended the 
use of cold water against the different varieties of it." 2 That he had 
an excellent understanding of the physiological action of water is 
readily appreciated when we find that he directed cold baths to be 
of short duration, preceded and followed by friction, thus showing 
that he understood the advantages of prompt reaction. 

Asclepiades of Prusa, in febrile diseases, ordered cold water to 
be drunk, and repeatedly praises the value of the cold bath, of the 

1 See illustration. Courtesy of Interstate Medical Journal. 

2 Winternitz, Wm. . "Hydrotherapy," Vol. IX, Ziemssen's Cyclopedia of Therapeutics. 



oo DBBoaoeooooooooaoaoooQDao 'ooooaaaoeaoooeaoiODoDoooooo 

^iniinnnniinmiinnTTTfflnnTWTTinTui^ 

i 




Plate 1 — Baths of Caracalla. 





Plate 2 — Strigilli. 
Courtesy Metropolitan Museum of Art, New York City. 



HISTORY OF HYDROTHERAPY. 3 

douche, rain baths and shampooing. In Rome, cold water treatment 
obtained a permanent place in the science of medicine, owing to the 
fact that Antonius Musa cured the Emperor Augustus by means of 
its application. But it was in the degenerate and luxurious period of 
Caesarean Rome that bathing reached the maximum of its ancient 
usage. From a personal study of the great Thermae of Rome and 
Pompeii, the writer was astounded at their extent and the perfection 
of equipment of these most ancient bath houses. The Thermae of 
Caracalla, or Antoninianae, were erected about 212 B.C. by the 
Emperor Caracalla, and completed by Severus. Their magnificence 
was unparalleled, and of such extent that they could accommodate 
sixteen hundred bathers at once. They were built mostly of red 
and orange-colored brickwork, and were supplied with water from 
the Antonine Aqueduct, which brought water to the baths for that 
special purpose. The object of their erection by the emperors was 
to ingratiate themselves with the people ; and in the construction of 
these enormous buildings they equipped them with private bathing- 
apartments, gymnasia, libraries, and sometimes even theatres. This 
establishment was quadrangular in form, surrounded by a wall, had 
its porticoes and race course. 

The technical effort displayed by the Roman architects, in ren- 
dering impervious to moisture the walls and sides of their reser- 
voirs, in constructing flues for the conveyance of hot air, and in 
conveying and heating water, showed a skill of the very highest 
order. The water was heated ingeniously. The heat which was 
not taken up by the first boiler passed on to the second, and, instead 
of being wasted, helped to heat the second — a principle which has 
only lately been introduced into modern furnaces. We enter first 
(see cut) the spacious oblong surrounded by columns (peristyle), 
and from there the bathers retired to the Spoliatorium, where they 
undressed. From here the bather entered the Tepidarium, where 
he remained for a short while, then passed into the Unctuarium, to 
be anointed with oils or unguents, and then into the Calidarium, or 
hot-air bath. From the Calidarium the bather entered the Suda- 
torium, or sweat room, which usually had large vessels containing 
hot water, from which the bathers sprinkled themselves while rub- 
bing off the perspiration. The temperature of the Sudatorium was 
regulated by drawing up or down a metallic plate. The richer Ro- 
mans used a variety of oils and pomades ( smegmata) ; they scarcely 
had true soaps. The poorer class had to be content with the flour 
of lentils, an article used in this day, for the same purpose, by Ori- 
entals. The most important bath utensil was the strigillus, a curved 
instrument made of metal, with which the skin was scraped and all 
sordes removed. 



4 PRACTICAL HYDROTHERAPY. 

After this he proceded to the Solium, or cold bath, from which he 
emerged to be rubbed and anointed. 

"Petronius woke only about midday, and, as usual, greatly wearied. 
The evening before he had been at one of Nero's feasts, which was 
prolonged till late at night. For some time his health had been fail- 
ing. He said himself that he woke up benumbed, as it were, and 
without power of collecting his thoughts. But the morning bath 
and the careful kneading of the body by trained slaves hastened 
gradually the course of his slothful blood, roused him, restored his 
strength, so that he issued from the eteothesium, that is, the last 
division of the bath, as if he had risen from the dead, with eyes 
gleaming with wit and gladness, rejuvenated, filled with life, exqui- 
site, so unapproachable that Otho himself could not compare with 
him, and was really that which he had been called — arbiter clcgan- 
tiarum." ( Sienkiewicz, "Quo Vadis.") 

Bathed, anointed, perfumed, in state and stately toga, he might 
then enter the Stadium and mingle with the literati and philosophers, 
listen to their discourses, and discuss the latest news. Such was the 
magnificence and luxury of these Thermae that one stands almost 
lost in the contemplation of their ancient grandeur. 

An idea of the magnificence of these baths may be obtained by 
a glance at some of the statuary taken from this Therma, and known 
as the Farnese collection — the Bull, the Hercules, and Faun — also 
the Torso Belvidere, a statue so perfect in its anatomy that Michael 
Angelo declared that he owed his power of representing the human 
form divine to its lines, and who, in his blind old age, used to be 
led up to it that he might pass his hands over its surface and still 
enjoy, through touch, the grandeur of its muscles. 

"The walls of the lofty apartments were covered with curious 
mosaics, that imitated the art of the pencil in elegance of design and 
in the variety of their colors. The Egyptian granite was beautifully 
encrusted with the precious green marble of Xumidia. A perpetual 
stream of hot water was poured into the capacious basins through 
many wide mouths of bright and massive silver ; and the meanest 
Roman could purchase, with a small copper coin, the daily enjoyment 
of a scene of pomp and luxury which might excite the envy of the 
kings of Asia." ( Gibbons, "History of the Roman People." ) Per- 
petual streams of water poured forth on all sides from the mouths 
of lions of bright and polished silver. "To such a pitch of luxury 
have we reached," says Seneca, "that we are dissatisfied if we do 
not tread on gems in our baths." 

"Consuls, emperors, and the great men of every age have found 
no better way of immortalizing their memories than by the shifting, 
indestructible, ever-new, yet unchanging, up-gush and down-fall of 
water. They have written their names in that unstable element, 
and proved it a more durable record than brass or marble." (Haw- 
thorne, "Marble Faun." ) 

"The habits of luxury and inertia which were introduced with 
the magnificent baths of the Emperors, were among the principal 



ffi 



60 
c 







HISTORY OF HYDROTHERAPY. 5 

causes of the decline and fall of Rome; and the vices which were 
encouraged in the baths found their reaction in the impression of the 
early Christians that uncleanness was a virtue, an impression which 
is retained by several of the monastic orders to the present day. 
Thousands of the Roman youth frittered away their hours in these 
magnificent halls, which were provided with everything which could 
gratify the senses." (Hare's "Walks in Rome.") 

Galen, 3 that bright light of medicine, was an able advocate of 
baths, especially of cold water, and advised cold affusions to the head 
while the body was immersed in warm water. Following Galen came 
the period of the Dark Ages, when every form of knowledge suffered 
from fraud and ignorance, and during which the whole world met 
with an irreparable loss in the burning of the great library at Alex- 
andria. During this time medicine, science and art were lost ; the 
great Roman Empire was rent asunder, plundered by the northern 
hordes, and it is not until A. D. 525 that we find any evidence of a 
real luminary on the hydriatic horizon. Rejecting all systems of 
medicine, Alexander of Tralles insisted, "with a true philosophical 
spirit, which would do credit to him to-day, that the physician must 
depend in each single case upon the age, constitution, and natural 
powers and mode of life of the patient, as well as upon the climate 
and allied conditions and effects of nature." He believed in the pour- 
ing upon the body of cold water, and in friction. 

Drawing the curtain of charity over the dark and barbaric Middle 
Ages, in which medicine, and with it hydrotherapy, suffered greatly, 
we come to a period when glimmerings of intelligence appeared in 
the distance. In the hands of quacks and charlatans, mixed and 
mystified by magical arts, hydrotherapy had fallen into shameful 
disrepute until the great surgeon, Ambroise Pare,* undertook its ref- 
ormation. With unabated zeal, with acute and accurate observation, 
by hard labor, he investigated its merits, especially in the treat- 
ment of wounds and fractures, and said : "I declare that it is not the 
words (of the incantation) nor the cross which do it, but the water 
which cleanses the wound, and protects the injured limb from inflam- 
mation and the attack of other fluids, by its coldness" (A. Pare, edit. 
Malgaigne, quoted by Winternitz). Passing again into a state of 
innocuous desuetude, hydrotherapy was not aroused from its lethargy 
until the advent of Floyer's work, which came out in London, in 
1697. He was an educated English physician, and his books passed 
rapidly through six editions, making many converts at home and 
abroad. He gathered in his books the data of preceding writings, 
both sacred and profane, and spoke favorably of the cold bath, and 

3 See illustration. Courtesy of Interstate Medical Journal. 

4 See illustration. Courtesy of the Librarian of Congress, from a stipple engraving by 
Wm. Hall, from the original picture in L'Ecole de Medecine (Paris). In the Portrait Gal- 
lery of distinguished poets, philosophers, etc. London, 1853, Vol. I, page 155. 



6 PRACTICAL HYDROTHERAPY. 

ascribed the increase of disease to the neglect of its use. He recog- 
nized the advantage of making the patient sweat before taking the 
cold bath, and used wet sheets and blankets to bring this about, a 
method frequently employed at the present day. under the appella- 
tion of the "wet sheet pack." 

Floyers writings and work began to make an impression upon 
the medical fraternity of Germany, and one of the first to appreciate 
it at its true value was the illustrious Friedrich Hoffman, at that time 
one of the foremost clinicians of Europe ; he attached much value to 
the medicinal action of water. Examining critically into the value of 
mineral waters in general, he came to the conclusion, which is most 
generally held at the present time, that the action of them is almost 
entirely due to the pure water they contain. 

In his observations and researches he noticed the behavior of tis- 
sues to the action of cold water, and was the first to call attention 
to the fact that tissue tone could be brought about by these appli- 
cations. 

The writings of this highly educated and philosophic physician 
left their imprint upon the medical thought of his day, and while he 
did not place its use upon any scientific or rational basis, yet he brought 
its advantages to the notice of, and made them clear to, the thoughtful 
and appreciative physicians of his time. 

The Japanese have used water in the treatment of disease for 
many years, and it is stated that Dr. Nakagami, three hundred years 
ago, recommended its use, particularly in mental and nervous dis- 
eases, while the same authority states that the cold bath has been in 
use in Japan for nearly eight hundred years, especially among the 
native country physicians. 

In 1786 James Currie 3 became much impressed with the impor- 
tance and results to be obtained by the application of hydrotherapy, 
and was attracted to its use through the publication of a fellow- 
countryman by the name of Wright. Possessed of a naturally philo- 
sophic and critical mind, and being a practical physician, it was not 
long before he discovered many important principles relating to 
hydrotherapy. He carried out quite a number of physiological ex- 
periments, watching each case carefully, and controlling each move 
in his treatment by means of thermometric observations. He was 
fond of prescribing the free drinking of large quantities of cold 
water, and did not become so enamored of his new practice as to 
forget the use of medicine, hygiene and dietetics. He employed cold 
water in the different forms of the exanthemata, paralysis, tetanus, 
convulsions, etc. 

5 See illustration. Courtesy of the Librarian of Congress, from a stipple engraving by 
William Thomas Fry, from a miniature by Thomas Hargreaves. in the British Gallery of 
Contemporary Portraits. London, 1822, Vol. I. page 71. 




Plate 4 — Hydrotherapeutic Wasters. 



HISTORY OF HYDROTHERAPY. 7 

Perhaps the modern birth of hydrotherapy took place with the 
advent of Vincenz Priessnitz. 6 A Silesian peasant, born in 1799, 
be began early in youth to adopt cold water applications for the treat- 
ment of sprains, contusions and swelling of horses' feet, using com- 
presses and bandages. He was peculiarly gifted with a clear insight, 
marked seriousness and genuine talent, and was much above the aver- 
age of his countrymen, having received a fairly good education. He 
was unfortunate enough to sustain a fracture of two of his ribs, and 
as the local country authority could not bring the broken ribs into a 
proper position, and when he became aware that he would have to 
face long suffering and deformity, Priessnitz determined to effect 
his own cure. "With the energy so natural to him, he first of all 
pressed his chest against the corner of a chair, and, holding his 
breath, he then brought the two ribs in position with his hands, fix- 
ing them there by means of a dressing formed of towels steeped in 
cold water ; then he drank water copiously and repeatedly, and found 
himself cured in a short time." While his methods were crude, and 
administered without much discrimination, we can pardon this when 
we realize that he possessed no physiological knowledge, nor had 
he the advantage of a medical education, or even being medically 
well read. 

He soon began to organize his various measures and remedies 
into a system which, though crude and empirical, yet resulted in 
such success as to compel attention from far and wide. In many in- 
stances his successes were phenomenal, particularly as he treated 
every one in the same manner, without regard to age or sex, and 
without attempting a diagnosis of their disease. His routine method 
of treatment was to place his patients upon a rough, coarse, though 
non-irritating diet ; compelling considerable muscular exertion, the 
drinking of large quantities of cold water, and the different external 
applications of this agent. For the latter purpose he used general 
and local baths, douches and friction, compresses and packs, some 
of the latter lasting as much as six hours ; and we find, about 1840, 
"that he could accommodate 1,576, which number grew yearly by 
new-comers from every part of the globe." He had to undergo the 
usual scoffing of the medical fraternity, but his lay success was such 
as to finally draw critical attention to his methods, and he thus paved 
the way for educated physicians to take up the study of this impor- 
tant remedy, among whom was the noted French physician Fleury, 
who later published an extensive practical treatise upon the subject. 

Priessnitz was not, as he is believed to be, the father of hydro- 
therapy. On the contrary, we find Hallmann stating, in the preface 

6 See illustration. Courtesy of the Librarian ot Congress, from a wood engraving in 
Harper's Magazine, Vol. LX, page 187, in connection with an article on "The Isms of Forty 
Years Ago." 



8 PRACTICAL HYDROTHERAPY. 

of his work, in 1843, that "thrice already has hydrotherapy offered 
its service to medicine." 

Currie announced the new study, and gave it a capital recom- 
mendation ; it was listened to by many, studied by few, and finally 
forgotten by all. Hufland, twenty years later, tried to obtain a hear- 
ing for it. Still twenty years later, it again spoke through the mouth 
of a layman, Priessnitz. Hydrotherapy is no enemy of medicine; 
on the contrary, it prides itself on being the daughter of the old 
Hippocratical medicine, and promises to be a powerful ally to its 
mother. 

The cuts give an idea of some of the local and general applica- 
tions of water that Priessnitz used, and which his mechanical ability 
enabled him to change or modify at will. Thus, medicine was once 
again to be compelled to accept a remedy far more valuable than 
nine out of ten medicinal measures, through the insistence, persist- 
ence and unquestionable ability of an ignorant but astute layman. 
Too often has this been the case, and alas ! it is sometimes true in 
the present day and generation. 

Fleury visited Priessnitz, and was so much impressed by the re- 
sults obtained by this empiric, that he returned to France to take 
up the systematic and careful study of hydriatic methods. His aim 
was to examine carefully into the physiologic and therapeutic value 
of each procedure, and it might be stated that he founded almost a 
separate school by the introduction of the "douche." He was a 
keen observer, a thoughtful man, and fortified his deductions by 
clinical results. 

In 1848 he published a work devoted to the douche and its appli- 
cation in intermittent fever, to be followed afterward by a treatise 
in which he showed the great value and success of the treatment 
of pseudoanchyloses, chlorosis and scrofula by the same means. It 
is astonishing to note the results he obtained by this method. 

In 1850, Hollman, a scientifically educated physician, studying the 
the results obtained by Priessnitz, became converted and entered upon 
the use of hydrotherapy. He sought to induce perspiration, in addi- 
tion to the abstraction of heat, by wet packing. 

To Bocker must be given the credit, at this time, of the most 
complete experimental investigation of the internal administration of 
water, which led to the law that the excretion of urea increased dur- 
ing the copious drinking of water, while the formation of uric acid 
is diminished, together with a diminution of the chlorides and phos- 
phates. 

In 1861, Ernest Brand, of Stettin, published the details of his now 
well known and celebrated treatment of typhoid by baths at a tem- 
perature ranging from 50° to 68° F It would be impossible, in a 
historic review, to more than mention the studies, labors and results 




Plate 5— The Early .Methods of Priessuitz (K 



ellogg). 



HISTORY OF HYDROTHERAPY. 9 

of Brand, and this matter will be entered into more fully and in 
detail when the consideration of the treatment of typhoid fever is 
taken up. 

Suffice it to say, however, that his studies and treatment clearly 
showed that the cold bath treatment lowers the body temperature, 
diminishes the grave symptoms, refreshes and strengthens the ner- 
vous system, probably shortens the course of the disease, and lessens 
the mortality. 

In 1863, Dr. John Chapman, an Englishman living in Paris, 
founded the application of the spinal ice-bag upon a law that "paral- 
ysis of the sympathetic nerves brought on dilatation of the vessels 
they supplied, and, consequently, peripheral hyperemia, with real 
increase of temperature ; whilst irritation of the sympathetic ganglia 
brought about contraction of the blood-vessels, and, consequently, 
anemia and lowering of temperature." They became of some value 
in the treatment of spinal and nervous diseases. 

It was, however, to Professor William Winternitz, 7 of Vienna, 
Austria, that the credit of placing hydrotherapy upon a scientific 
basis is due. This investigator brought to his work full knowledge, 
a discerning mind, and an enthusiasm that knew no bar, nor allowed 
any difficulty to prevent the accomplishment of his purposes. His 
studies upon the influence of hydrotherapy upon metabolism, the 
blood, excretion, the application of heat and cold, are monuments 
of scientific care and pains, while his deductions show the logic of 
a true investigator, a mind of broad gauge and ample qualification. 
It was through his investigations that we are able to know definitely 
that the influence of cold water procedures upon the nervous system 
was a stimulus, a fact of much more importance than the mere phys- 
ical action of loss of heat. With this knowledge at his command, 
he began to study and make use of hydrotherapy in the treatment 
of the different forms of disease that came under his care. It was, 
however, not until 1876 that he published his work, and described 
fully the influence of hydrotherapy on the circulation and innerva- 
tion. The author here acknowledges not only his indebtedness to 
the classic studies and works of Prof. Winternitz, but he owes to the 
personal charm of the man his first desire to study and investigate 
this method of therapeutic procedure. The observations made at 
his clinic remain fresh and strong among the many recollections of 
his student life. It was through Winternitz's work and influence 
that Vienna has become the great modern center of hydrotherapy, 
and from which many of the successful results of treatment have 
originated. 

Among modern physicians, Dujardin Beaumetz has placed the 
stamp of his approval upon the use of hydrotherapy in its many 

7 See illustration. Courtesy of Modern Medicine and Bacteriological Review, June, 1902, 



10 PRACTICAL HYDROTHERAPY. 

forms. There are few will gainsay the experience and judgment 
of Prof. Erb in the treatment of disease within his specialty (ner- 
vous diseases), and an expression of opinion from one who is en- 
tirely freed from the vice of using a single therapeutic method must 
be doubly felt when we read his statement made in Yon Ziemssen's 
Cyclopedia, as follows : 

"To the most important and most active therapeutics of our field 
belong cool and cold baths, viz., the application of cold water in its 
most varied forms, that which is usually termed 'cold water treat- 
ment.' Its results in all possible forms of chronic nervous diseases 
are extraordinarily favorable. If we add to this the heightened skin 
and muscular action induced by various methods of bathing, it be- 
comes evident that we possess few remedies which produce an equally 
powerful effect." 

Of recent years American physicians have taken up the subject 
of hydrotherapy and its associated procedures, and have constantly 
impressed their value upon the profession of this country. 

No historical review of hydrotherapy would be complete without 
a tribute to two American masters in this department — J. H. Kellogg 
and Simon Baruch. These men, above all others, have stood for the 
honest, scientific and practical application of water to disease. They, 
much more so than the author, for they have worked longer in the 
pioneer field than he, can recall all the difficulties and all the preju- 
dices that met their early efforts. They have, fortunately, lived to 
see the day when the profession is awakening to view as they did 
a valuable and powerful therapeutic weapon. Their studies and 
contributions, covering three decades, will ever be an honor to Amer- 
ican hydrotherapy. 

Hydrotherapy has seen its ups and downs, its periods of fluctu- 
ation, its cycles of existence and non-existence. In ancient times it 
was used only to be lost, and later revived to be lost again. In mod- 
ern medicine hydrotherapy has come to stay, and, were I to predict, 
I would certainly say that it will never again reach the shades, nor 
depart from the usage of intelligent physicians. To-day the medical 
profession is too broad in its beliefs to permit the extinction or loss 
of any procedure by which results may be obtained ; and, having 
been freed from empiricism, and built upon the strong bulwark of 
physiological study, we may hope that the intelligent medical man 
will never again allow it to be lost sight of, but will use it as one of 
the most powerful and satisfactory of therapeutic resources. 



nj 



r 

-t 



T) 



o 





Plate 7 — Early Methods of Priessnitz (Kellogg). 



CHAPTER II. 

GENERAL CONSIDERATIONS.— ANATOMY AND PHYSIOLOGY 

OF THE SKIN. 

Hydrotherapy is the application of water in or upon any part of 
the human body for remedial purposes. It is a remedy that requires 
a thorough and practical knowledge of anatomy and physiology. When 
properly handled and in experienced hands, it is an agent capable 
of producing results not equalled by any therapeutic procedure in 
the domain of medicine. In its application, not only is it necessary 
to know physiological function, but the pathological modification of 
tissue resulting from disease. Of all physicians, the hydrotherapeu- 
tist should possess an accurate knowledge of the anatomy and physi- 
ology of the nervous, skin and blood-vascular systems. 

The author, while possessing the most thorough appreciation of 
the advantage and value of hydrotherapy, fully realizes that it is 
not a cure-all, nor is it intended to convey such an idea. The great 
tendency of enthusiastic therapeutists to lean upon one single method 
of procedure cannot be too heartily condemned, and it is with a full 
comprehension of the real value, and the limitations of this agent, 
that this book has been written. 

It will be noticed, especially in the therapeutic portion of the 
volume, that other methods are suggested as of primary importance, 
and water as its corollary, and vice versa. Too often enthusiasm has 
carried the user of water far beyond the domain of truth, and it is 
here again reiterated that its true and full value is developed only 
in the hands of those who bring to it a just and scientific apprecia- 
tion of its limitations. 

It is an agent that is, or should be, in daily use from birth until 
death, and not only is it of value as a remedial measure, but it is 
a useful agent in the preservation of health. Its application in the 
treatment of disease is an art, and can be acquired only by the exer- 
cise of experience. Its haphazard, desultory and careless application 
is just as much contraindicated as the same method would be in the 
prescribing of drugs. Correct diagnosis, an appreciation of the clin- 
ical indications, and a full knowledge of the physiological action 
of the agent used, are necessary to its proper use. Many methods, 
especially in acute and subacute diseases, require little, if any, appa- 
ratus ; and, in fact, in many of the best applications in these condi- 
tions, the paraphernalia can be found in any household, even the hum- 
(11) 



12 PRACTICAL HYDROTHERAPY. 

blest. It is in the domain of chronic diseases and disorders that the 
more bulky and non-portable apparati are needed, and these are to 
be found in institutions devoted to the treatment of this class of 
sufferers. 

The Physical Properties of Water. 

Water is a constituent of every tissue of the human body, from 
0.2 per cent, in the enamel of the teeth to 99 per cent, in the tears. 
It is necessary to the performance of every function of the organ- 
ism. In its fluid-like form water lends itself readily to applications 
to the body. The physical changes to which it may be subjected 
run from 32° F., ice, to 212° F., steam, when, under ordinary cir- 
cumstances, it attains a volume seventeen hundred times greater, and 
becomes quite elastic. It can thus be readily seen what an enormous 
opportunity is offered in its application to the periphery of the human 
body, both for general and local effects. It possesses cleansing and 
antiseptic properties, and this is one of the principal uses in ordinary 
application. The physical properties of water in its hydrotherapeutic 
application consist of the following: 

1. Thermic Action. — Water absorbs more heat for a given weight 
than any other substance, and communicates this with great rapidity 
to objects with which it comes in contact, and therefore it is readily 
adapted for making applications of varying temperatures to the 
human body. The ease and rapidity with which we may vary the 
thermic influence adds to its efficiency. General therapeutic applica- 
tions may be made between the temperatures of 34° and 120° F. ; 
locally, 34° to 160° F. ; a range of temperature effects unobtainable 
and unequalled by any other known remedial measure. 

2. Mechanical Effects. — Water, possessing a certain weight, makes 
it possible under pressure to obtain vibratory or mechanical effects 
that are extremely valuable to the hydriatist. The forcible impact 
of water of varying degrees of pressure, influences by its mechanical 
action the peripheral nerve endings and blood supply, independent 
of the thermic action. 

3. Adaptability. — The ease and rapidity with which this agent 
may be changed and varied in a precise and certain manner, so that 
the attendant has under his control, within a few seconds of time, 
the temperature, pressure, form of application, and duration, renders 
it, without question, the remedy par excellence for these effects. Its 
form, size, weight and fluidity being under perfect control, makes it 
adaptable to any and all portions of the body with a precision and 
satisfaction offered by no other thermic agent. 

4. Cleansing. Antiseptic Action. — There is no agent equal to water 
in its cleansing action, and the daily bath is, as a rule, part and parcel 
of civilized mankind's daily routine. As an antiseptic, pure water 



ANATOMY AND PHYSIOLOGY OF THE SKIN. 13 

finds its uses innumerable in the surgical and medical field, while 
internally it is not only an antiseptic, but a diluent. 

It may be stated that water, when properly used, keeps the body 
in health, prevents the onset of disease, resists the attacks of patho- 
genic bacteria, and is, as Hoffman says, "more nearly a panacea for 
human ills than any other known agent." 

Anatomy of the Skin. 

As scientific therapy of any kind should be based upon anatomi- 
cal and physiological considerations, it is necessary to first consider 
the structures and functions of the human skin, it being the princi- 
pal organ to which water is applied. The skin is tough, flexible and 
highly elastic ; it consists of fibro-areolar tissue, contains blood-ves- 
sels, lymphatics, glands and nerves. It is the principal seat of the 
sense of touch, and is an important excretory organ, containing, as 
it does, the sweat and sebaceous glands. 

The skin consists of two layers : 

1. The corium, or cutis vera. 

2. The epidermis. n 

It is closely connected to adjacent parts by means of the sub- 
cutaneous cellular tissue, into which the follicles of the hair and the 
different glands of the skin project. 

The true skin consists almost entirely of fibro-areolar tissue ; 
the firm white fibrous tissue forming with the yellow elastic fibers 
a strong framework for the structures of the skin. This tissue is 
most abundant in the lower layers of the corium, becoming finer 
toward the surface. 

The areolae form channels by which the blood-vessels, nerves, 
glands, etc., are distributed superficially, and the interspaces between 
these are usually occupied by fat cells. Unstriped muscular fibers, 
abundant in the upper portion of the cutis, are usually located around 
the hairs. Situated near the free surface of the true skin is the papil- 
lary layer, consisting almost entirely of blood-vessels. These papillae, 
or projections, rise perpendicularly to the surface, and are highly 
sensitive. 

Their number and distribution vary proportionately with the sen- 
sitiveness of the skin ; that is to say, the more sensitive portions being 
supplied very much more richly with papillae. 

The larger and smaller papillae contain a capillary loop, convo- 
luted to a greater or lesser extent, and in addition one or more nerve 
fibers, in some sections intimately associated with the "tactile cor- 
puscles." 

The epidermis, or scarf skin, consists of many layers of stratified 
epithelium, molded or cemented together. These cells are of various 
sizes, shapes and hardness, the inner layer being soft and the outer 



14 PRACTICAL HYDROTHERAPY. 

hard. The superficial cells of the epidermis are being constantly 
thrown off and their place taken by the newer cells of the deeper 
structure. These external hardened and flattened cells are removed 
in great numbers after a bath followed by friction. The epidermis 
serves as a protective layer to the cutis, and prevents and limits evap- 
oration from the blood-vessels which come close to, or against, its 
inner margin. It possesses on its surface lineal markings or furrows 
of variable size and disposition, the projections between the furrows 
depending upon the peculiar arrangement of the papillae. 

The blood supply of the skin is derived from arteries located 
in the subcutaneous tissue, numerous branches J of which pass through 
the areolae of the cutis, dividing into dense capillary plexuses, from 
which numerous twigs ascend perpendicularly into the papillary layer. 
It is from this network of capillaries that the glandular structures 
and the hairs are likewise supplied. 

The gross nerve supply to the skin is derived from the cerebro- 
spinal system, and consists of medullated and non-medullated fibers. 
They are distributed over the entire skin in relation to the different 
spinal segments. The nerve fibrils form a plexus in the corium, and 
from this plexus neuraxons ascend to be distributed to the papillae, 
and to terminate in the corpuscular bodies associated with sensation. 
Fibrils are distributed to the hair follicles, sweat and sebaceous 
glands. The nerve supply of the skin is most extensive, among 
which are fibrils that govern temperature (heat and cold), touch, 
pain, and the vasomotors. 

The sudoriferous or sweat glands are found in enormous num- 
bers opening upon the surface of the skin. They are about 1-56 of 
a line, and their total number is estimated by Krause at 2,381,248. 
They vary in number per square inch, from 417 on the neck and 
back to 2,800 on the palms of the hand. They are found in the small 
pits in the corium, and extend deeply into the subcutaneous cellular 
tissue, being usually surrounded by a quantity of adipose tissue. 
They are lobulated bodies consisting of convoluted tubes, from which 
a duct proceeds through the true skin and opens upon the surface 
of the epidermis. The duct is usually spiral in its course, and opens 
upon the skin in a more or less oblique or valve-like manner. 

The sebaceous glands are found in the cutis projecting into the 
subcutaneous cellular tissue. These are small sacculated glandular 
organs, consisting of a single duct which terminates in a more or 
less racemose manner or in a lobulated pouch-like extremity. The 
duct is lined with epithelium and usually filled with particles of seba- 
ceous matter, which constitute its secretion. The ducts open mostly 
into the hair follicles, but in some positions, as in the face, directly 
upon the general skin surface. These glands are most abundant in 
the scalp, face, and especially around apertures where there is a 











mm 'Sp % » fMM^ 

m/JrM-1(ik:> :53Plm.--r. ■• /&.?{. ,■ ■ J-jpt ■■■■■-■-■ / 




Plate 8 — Microscopic Section of Skin. 




Platf. 9 — Microscopic Section Injected, Showing Skin Circulation. 



ANATOMY AND PHYSIOLOGY OF THE SKIN. 15 

junction of the skin and mucous membrane; they are absent upon 
the palms of the hands and feet. 

Physiology of the Skin. 

The physiology or function of the skin may be considered as 
follows : 

1. As a protective covering. 

2. As a sensory organ. 

3. As an excretory organ. 

4. As a vascular organ. 

5. As an organ for the regulation of heat. 

1. Protective Covering. — The skin and its subcutaneous cellular 
tissue not only fills up depressions, covers projecting points and in- 
creases the cosmetic appearance of the body, but serves as a firm, 
easily movable and soft elastic pad to protect delicate and sensitive 
spots from external and mechanical injury. The epidermis, being a 
dry, horny substance, devoid of nerves and blood-vessels, acts as 
a resistive body to the entrance of foreign substances from without. 
Its pressure upon the capillaries in the papillary layer prevents evap- 
oration and too great a diffusion of liquids. The epidermis is a bad 
conductor of heat, watery vapor and electricity. 

2. Sensory Organ.- — This is, of all, the greatest function of the 
skin, for by means of the nerve endings terminating upon the surface 
of the skin, it serves the purpose of bringing the human organism 
into contact with, or conscious of, the external world. Through its 
nerve supply we are capable of feeling the contact of objects with 
the skin (touch or tactile sense), the varying degrees of thermic 
change (temperature sense), disagreeable and painful sensations (the 
pain sense). Tactile sensation, or the sense of touch, as previously 
mentioned, is mostly served through utilization of the touch cor- 
puscles of Wagner and Meissner, Pacini and Golgi. These nerve 
terminations are capable of recognizing specific sensations of all 
kinds. So intimately are the nerves disposed, that in all portions 
of the body the slightest touch with a fine cambric needle is not only 
appreciated, but pain as well as touch is felt. 

Modern investigators now separate the nerve endings into dis- 
tinct and specific points for the recognition of the different sensa- 
tions, and believe that there are specific end-organs which appreciate 
the varying sensations of touch, locality, pressure, pain and tempera- 
ture. The intimate association of the skin with the cerebro-spinal 
and sympathetic systems of nerves makes the skin an organ capable 
of producing the profoundest reflex influences upon distant organs 
and functions, and, as it is constantly exposed to varying conditions 
of irritation, so does it produce varying influences upon different 
portions of the body by means of its referred and reflex action. The 



16 PRACTICAL HYDROTHERAPY. 

study of the minute anatomy of the spinal cord lends additional 
belief to the view here expressed, that these sensations are subserved 
by different nerve fibers, which are ultimately gathered into the dif- 
ferent columns functionally related to these sensations. However, 
it may be said that the sensations of the cutis, while different, are 
yet closely united, and that the neural mechanism of the skin is dis- 
tinctly a conjoint and complicated one, with difficulty of separation, 
so far as its sensory impressions are concerned. The sensibility of 
the skin is greatly influenced by certain conditions, which should be 
borne in mind by the hydriatist. 

Exercise and moistening of the skin increase its acuteness and 
activity. The temperature sense of the skin is very much more acute, 
rapid and exact for cold than for heat; in fact, heat sensations are, 
as a rule, developed slowly and less accurately. Sudden change from 
one temperature to another, especially from heat to cold, is felt more 
acutely than the reverse; the application of heat followed by that 
of cold is of a more stimulating effect than vice versa. Temperature, 
especially cold, is felt more acutely if it is accompanied by weight 
or pressure, and may reach such a point as to be in either event 
painful. The terms heat and cold are purely relative; a body possess- 
ing a sensation of warmth when heat is communicated to the skin, 
and is felt as cold when it robs the skin of heat. The body appre- 
ciates varying degrees of temperature in proportion to the richness 
of the nerve supply. Practice develops the temperature sense, and 
brings forth a more accurate and acute appreciation of its influences. 
When large areas of the skin are brought in contact with bodies of 
varying temperature, the sensation is felt more sensibly than if the 
area is small. 

Pain may occur whenever a strong stimulus is applied to a sen- 
sory nerve. All kinds of stimuli may produce pain provided they are 
stronger than normal ; thus, mechanical, thermic, chemical, electrical 
or somatic disturbances may produce pain. The intensity of the 
pain usually depends upon the excitability of the sensory nerves, the 
extent of the stimulus and its degree. 

3. Excretory Organ. — The most important secreto-excretory func- 
tions of the skin are (a) sudoriferous, (b) sebaceous, (c) respiratory. 

Sweat, the secretion of the sweat glands above described, is se- 
creted in the coil of the gland, and finds its exit upon the skin. 
Under ordinary circumstances it is secreted in such quantities that 
when it reaches the surface of the skin it is at once evaporated, con- 
stituting what is known as insensible perspiration, amounting to one 
or one and one-half ounces per hour. Under certain conditions, 
however, as exposure to external warmth, exertion, nervous im- 
pressions, and in some diseases, the secretion increases rapidly, col- 
lects in the form of drops on the external surface, is then known as 




Plate 10 — Microscopic Section of Skin, Showing Sebaceous Glands. 




Plate 11 — Microscopic Section of Skin, Showing Glandular Structures. 



ANATOMY AND PHYSIOLOGY OF THE SKIN. 17 

sensible perspiration, and may amount to as much as thirty to fifty 
ounces per hour. [The most active secretory portions of the body 
are the palms of the hand, the cheek, forehead, soles of the feet, 
breasts and upper armT\ Perspiration is favored by the agencies men- 
tioned above, and also by the free drinking of fluids, especially water; 
external applications of alcohol diminish the quantity. Sweat is al- 
kaline in reaction, but becomes acid, owing to the admixture of fatty 
acids and decomposing sebum. The quantity secreted has something 
to do with its reaction ; the more profuse the perspiration the nearer 
does it reach a neutral reaction. It has a salty taste, a peculiar and 
characteristic odor, due to the presence of sebum in the sweat. The 
fatty acids found in the sweat, and influencing its reaction and odor, 
are palmitin, stearin, formic, acetic and butyric acids. Urea is also 
present in very small quantities. The function of this secretion is 
of great importance to health ; a proper maintenance of its activity a 
sine qua non. The extensive glandular structures associated with 
this function permit of an enormous discharge. Anatomists have 
called attention to the close resemblance in the anatomical structure 
of the skin and kidney, pointing out the resemblance of the glomeruli 
to the coiled sweat glands, while chemists have noted the resemblance 
of perspiration and the urine. Bouchard has shown it to contain a 
powerful toxin, capable of lowering body temperature!) It! is a com- 
mon and daily observation with clinical hydriatists that there is an 
intimate and close relation between the skin and the kidney, and that 
the former may become an important aid to the action of the latter. 
In pathological states the action of the skin is usually increased, a 
safety valve in those conditions in which the integrity of the kidney 
is threatened// The nervous system influences the secretion of sweat 
through the action of special secretory nerves accompanying vaso- 
dilators, the resultant of whose action is a red and congested skin 
followed by free action of the glands. 

Adamkiewicz states that the dominating sweat center is located 
in the medulla oblongata. Jjhe epithelium lining the sweat glands 
after free perspiration becomes granular and the nucleus more cen- 
tral (Renaut).J 

^Healthful activity of the skin is a condition most essential to 
physical well-being. The state of inactivity of this organ, found 
present in nearly all chronic maladies, is not only a consequence, but a 
cause of a large number of serious morbid conditions of the body. 
It is in a great majority of cases quite impossible to effect a cure 
until the skin has, by patient, persevering treatment and training, 
been brought into a healthy state. The dry, sallow, dingy skin is due 
to the accumulation of effete matters in it, and to its impaired nu- 
tritiom/ p. 

The excretion of sebaceous matter keeps the skin supple and pre- 



18 PRACTICAL HYDROTHERAPY. 

vents the hair from becoming too dry. [It is slowly discharged from 
the excretory ducts of the sebaceous glands, and is composed mostly 
of fatty granules, a few gland cells and crystals of cholesterin. This 
excretion gives the perspiration its characteristic odor. The skin 
possesses respiratory functions. Roehrig believes that carbon di- 
oxide and water are excreted from the capillary vessels in varying 
proportions, the exchange of gases depending largely upon the vas- 
cularity of the skin. It is a well-known fact that total suppression of 
cutaneous activity will cause death. / 

^v 4. The Skin as a 1'ascular Organ. — An anatomical consideration 
of the skin shows it to be one of the most richly supplied of the or- 
gans with small blood-vessels, especially capillary ones, and it can 
be readily appreciated that any agent that will influence or change 
the blood stream from without to within, or vice versa, is an agent 
capable of exercising a profound influence both in health and dis- 
ease. The small arteries and capillaries of the skin are elastic; 
consist of a single layer of transparent, excessively thin, nucleated 
endothelial cells joined to each other by their margins, and possessing 
the power of contraction and expansion. The small arteries and cap- 
illaries are nothing more or less than the terminal branches of the 
heart, and it is through these that the systemic circulation takes place. 
The great vascularity of the skeletal muscles and their close relation 
to the skin, aid materially in stimulating normal activity of the cir- 
culating stream through the cutaneous surface. The skin responds 
with promptness to any stimulant of a circulatory character, and 
particularly those influencing its nerve supply governing the diam- 
eter of its blood-vessels. The intimate relation between cardiac ac- 
tivity, blood pressure and vascular activity in the skin, is a matter 
that will be more extensively dwelt upon when we come to consider 
the action of water upon the circulation. It may be stated, however, 
that the muscular and cutaneous surfaces are capable of controlling 
and holding approximately 60 per cent, of the entire blood of the body. 
Hydrotherapeutic applications influence extensively the vascularity of 
the skin, and also the action of the heart and pulse. 

5. The Skin as an Organ for the Regulation of Heat.— The origin 
of heat in the human body is to be sought for in the food ingested, 
principally those of non-nitrogenous bodies, oxidized within the body, 
mostly in muscular structures. The method of its production is that 
of disassimilation or destruction, in which oxygen is the oxidizing 
agent. Its production takes place in nearly all the processes that 
are necessary to the maintenance of health. Function is accompanied 
with more or less development of heat, the amount generated being 
related to the functional activity of an organ. Healthy, strong, robust 
persons generate more heat than delicate ones; more while actively 
exercising than when passive. 



ANATOMY AND PHYSIOLOGY OF THE SKIN. 19 

The body temperature is nearly constant, although it may be sub- 
jected to great external variations. Temperature impressions are 
conveyed over thermic nerves to centers located in the brain and 
spinal cord, which are in close and intimate relation with the vaso- 
motor centers and those of the abdominal splanchnic nerve. These 
thermic impressions bring the blood to the surface, thus enabling the 
surplus heat of the internal viscera to be dissipated and lost by evap- 
oration, conduction and radiation. The internal temperature is con- 
siderably higher than that of the surface, the equipoise of heat pro- 
duction and heat elimination being maintained by the skin. When 
the skin is brought in contact with a lower temperature, there is a 
contraction of the peripheral vessels, which, if the extent is sufficient, 
causes involuntary muscular movements. At the same time there is 
an active dilatation of the blood-vessels in adjacent parts, to prevent 
further entrance to cold. Reflexly, the heart action is strengthened, 
driving more rapidly the current of blood through the cutaneous sur- 
face and muscular structures underlying it. The musculature of 
the skin, reacting to cold, contracts and produces cutis anserina, or 
"goose skin." The thermic stimulation arouses the automatic cen- 
ters located within the spinal cord and brain to increased production 
of heat, through stimulation or paresis of the inhibitory fibers. Per- 
spiration is checked, evaporation prevented, heat retained, the skin 
becoming pale and the epithelium more dry. 

The exposure of the body to a higher external temperature influ- 
ences the thermic nerve terminations in the skin, lessening, through the 
inhibitory centers in the spinal cord and brain, the production of heat. 
At the same time impressions are conveyed to the automatic centers 
of the vaso-motor system, which results in the dilatation of the im- 
mense vascular area in the skin, accompanied by the contraction of 
the blood-vessels of the internal viscera. The superheated blood is 
thrown to the surface, the production of heat in the internal viscera 
lessened, and functional activity of these organs limited. 

Perspiration breaks out closely related to the amount of thermic 
irritation, and the perspiration, evaporation and heat radiation coun- 
teract the unusual thermic excitement upon the surface. If the irri- 
tant is carried too far, a paresis of the blood-vessels of the skin takes 
place, and a congested state is the result. Owing to the slow circula- 
tion through the internal organs, less heat is produced, and the body 
protected against overheating. The heart's action is accelerated; the 
stream of blood is more rapidly and frequently brought from center 
to periphery, is thus cooled and recooled; not only is the circulating 
medium more frequently passing through the blood-vessels, but their 
dilated condition is favorable for rapid and prompt loss of heat. 

Kellogg 1 says: "The surface over which the blood is spread is not 

1 Kellogg, J. H.: "Rational Hydrotherapy," 1907, p. 84. 



20 PRACTICAL HYDROTHERAPY. 

fully represented by the seventeen square feet of skin surface, but 
rather by the 11,000 square feet of surface over which the capillaries 
are spread in the walls of the perspiratory tubules — six times the 
surface presented by the lungs." Respiration is more rapid, and heat 
loss favored by evaporation, from the large area presented by the 
pulmonary mucous membrane. 

It will be noted that in the conservation of heat and its dissipa- 
tion, the mechanism governing both is reciprocal, production and loss 
being the result of nervous action, maintaining an equilibrium by vari- 
ations in the vascularity, secretion and functionation of the skin. 



CHAPTER III. 

PHYSIOLOGICAL ACTION OF WATER EXTERNALLY 
APPLIED. 

The skin, anatomically and physiologically, is capable of standing' 
abnormal changes and strains placed upon it. In order to appreciate 
fully the physiological action of hydrotherapeutic applications, it 
will be necessary to consider somewhat in detail the action of heat 
and cold upon the various functions directly resident in the skin itself, 
as well as effects upon distant organs, tissues and functions, the re- 
sult of nervous or reflex action. These are brought about through 
the perturbation of the sensory nerve endings in the skin by thermic 
and mechanical stimuli, are conveyed to the central and sympathetic 
nervous systems, impressions that start in actions myriad minute 
responses within the nervous system itself as well as the body struc- 
tures and functions. The sensory nerves thus become the hydriatist's 
medium of excitation. 

Hydrotherapeutic applications may be used to influence and affect: 

1. Temperature. 

2. Circulation. 

3. Respiration. 

4. Metabolism. 

5. Nervous system. 

6. Muscular system. 

7. Blood. 

In addition to which we must consider : 

8. Hydrotherapeutic reaction. 

9. Contraindications. 

Taking a normal or "neutral" line, the temperature of which 
ranges between 92° and 96° F., temperature effects are produced as 
we rise above or fall below this level, and it serves as a central or 
median place from which to classify baths or hydriatic applications. 
This neutral or normal temperature is so called because it does not 
disturb or perturbate the sensory nervous system, but shuts out all 
impressions, and by its negativeness calms the peripheral as well ag 
the central nervous systems. 

Starting, then, with the neutral or normal line, we base our classi- 
fication according to temperature, which of necessity requires some 
latitude, and is more or less arbitrary and artificial. 
(21) 



22 PRACTICAL HYDROTHERAPY. 

\-\ 

Very cold 34 deg. to 55 deg. ^ / 'b 

Cold 55 - " 65 " S L , -\ ~] , 

Cool 65 - '• 80 '• V \ A 

Tepid 80 " " 02 « \X V 

Neutral, normal, line 92 " " 96 " C\,"U S ^bV 

Warm 96 " " 98 " ^ ^ 

Hot 98 " " 104 " *7 V 

\'ery hot 104 and above. ^» ■- H 

"Man owes his relative constancy of temperature to great appa- 
rati of clothing, habitation, artificial heat by fires, stoves and volun- 
tary movements, and the necessity for placing at the head of the list 
of all conditions subservient to the maintenance of life is that of 
warmth, which is even more important to be attended to than nourish- 
ment itself." (Samuel.) "No matter how manifold the measures may 
be which the nature of the more highly organized animals has endowed 
them with, in order to enable them to maintain the heat of their own 
interiors against the changes of external temperatures, and no matter 
how well they may understand by their instinct to support these 
measures, yet they only fulfill the requirements put to them within 
the very narrow limits of the most favorable conditions. Beyond 
these, as a matter of fact, the native heat to warm-blooded animals 
is wanting in that renowned stability which one has been in the habit 
of considering to be one of the most marvelous facts in nature. 
When we are in our clothing we are in the same condition we should 
be in if we were naked in a specific atmosphere at the temperature 
of from 24° to 30° C. (75.2 to 86° F.). The temperature of separate 
climatic regions between the skin and clothes, therefore, is a much 
more constant one than we might at first glance suppose, judging by 
the great difference of temperature between the blood, and compen- 
sated by fresh waves of arterial blood, connected to the part to which 
cold is applied, and the converse is true in extreme applications of 
heat." And that "the amount of temperature reduction depends more 
upon the intensity of the thermic irritation of the cutaneous sensory 
nerves than any other element," has been pointed out by Winternitz. 

That the application of varying temperatures has its influence upon 
organic life, is well known to all physiologists, and is capable of easy 
demonstration. Most of us have observed under the microscope the 
slowing of the cilia of epithelium under cold, its stimulation by mod- 
erate temperatures of heat, and its suspension of movements by both 
extremes. A full knowledge of these responses, independent of me- 
chanical stimulation, enables the hydrotherapeutist to play upon the 
skin in a marvelous manner. That cold diminishes vital activity, and 
that heat enhances it, is a daily observation. The essential effects 
of heat and cold upon the organism in health are practically the same 
when applied to pathological conditions, and its ability to produce 
normal responses in diseased tissues results in restoring to them their 



PHYSIOLOGICAL ACTION OF WATER. 23 

lost equilibrium. Great latitude exists in different persons with re- 
gard to the appreciation of heat and cold. These impressions vary 
considerably in different parts of the body, and are influenced by the 
nervous condition, circulatory processes, and reactive capacity of the 
individual. 

Physiological Action Upon Temperature. 

The normal temperature of the human body is usually 98.6° F., 
but it may rise .5° in the mouth — to 99.1° F. Increased temperature 
may be induced physiologically by exercise, mechanical stimulation, 
thermic irritation, and may be augmented (or decreased) by many 
pathological states. Where thermic irritation causes a rise in tem- 
perature, this is brought about reflexly from irritation of the sensory 
nerves of the surface, carrying impressions and acting upon thermo- 
genetic centers located in the medulla, governing automatic centers 
located in the spinal cord, these in turn having control of those tissues 
mostly concerned in the production of heat, that is, the muscles. 
These medullary centers may increase or decrease or inhibit the 
lower automatic centers. But reflex action is not the only way in 
which the nervous system is stimulated to regulate heat generation 
and loss. The surface blood, absorbing or losing heat, as the case 
may be, bathes the neurons in a blood of higher or lower temperature, 
as a result of which they respond. Increased bodily temperature 
may result from several conditions — (a) increased heat production, 
(b) decreased heat elimination, and (c) a combination of the two, 
both increased production and decreased elimination. This in hydri- 
atics may be accomplished even by a warm bath of a few degrees of 
temperature above the body, or warm or hot air of varying tempera- 
tures. These produce their effects by preventing heat elimination 
from the skin, by conducting heat into and through the skin to the 
tissues below, thereby raising their temperature. The mere pres- 
ence of heat stimulates vital activity and at the same time increases 
bodily production. Temperature is quickly raised by baths at 105° F. 
and over, Kellogg 1 having shown that there is a rise of 1° F. in bodily 
temperature for every 20° F. in the surrounding media. When the 
bodily temperature rises, the natural forces are aroused to meet the 
changed conditions, in an endeavor to eliminate heat. The intimate 
relation of the thermic centers with the vasomotors enables this to 
be done through their action upon the vascular system, by dilating 
the superficial blood-vessels and carrying more blood to the surface 
to be cooled ; by contracting the visceral blood-vessels, lessening func- 
tion and heat production ; by accelerating the heart action so that 
the blood is more frequently passed through the superficial blood- 
vessels ; by increasing the respiration so that the blood is oftener 

1 Kellogg, J. H. : "Rational Hydrotherapy," 1906, p. 159. 



24 PRACTICAL HYDROTHERAPY. 

cooled; by perspiration, in which heat is lost through conduction, 
radiation and evaporation, the last a distinct cooling method. It is 
eminently a blood vascular process. 

Decreased bodily temperature may result from (a) decreased heat 
production, (fe) increased heat elimination, and (c) a combination 
of both, diminished production and increased elimination. This de- 
creased state cannot in hydriatics be produced by brief cold appli- 
cations, reaction occurring and preventing the loss by all those changes 
incident to it. Short, brief methods reflexly stimulate the thermo- 
genetic centers which accelerate the production of heat, especially in 
the interior, as well as in the thermogenetic tissues of the body, the 
muscles. This increased formation is retained in the body, owing 
to the contracted skin. Heat loss is lessened by the slowed heart 
action sending less blood to the surface ; by checking perspiration and 
contracting the blood-vessels less blood is exposed ; by diminished 
respiration, so that little evaporation occurs and less air needs heating. 

The Physiological Action of Heat on Temperature. 

The temperature at which water is recognized as being warm or 
hot commences at about 98° F., and ranges between this figure and 
104° to 105° F., above which point all temperatures are hot. Tem- 
peratures of 120° in general applications are endured by some few 
persons, but are borne with difficulty by the majority of humanity. 

As soon as the body is surrounded by a medium of higher tem- 
perature, the medium begins to lose and the body to acquire heat by 
conduction from the medium into the skin and tissues of the body. 
Being submerged in water even a few degrees higher than the body, 
prevents the usual heat loss from the skin, so that heat is retained from 
failure of the skin to eliminate it. The rise in body temperature is 
fairly proportional to the duration and temperature of the surround- 
ing medium. This rise, ranging in my own observation from .5° F. to 
even 2° F., continues until the vital forces respond and throw off the 
effect. 

As the tissues heat up and the surface temperature rises, the 
blood absorbs the heat, and this current, now superheated, sets in 
toward the thermic centers in the medulla and cord. These begin at 
once to respond in their endeavor to throw off the irritant, accom- 
plishing this result by all those means that bring about heat loss. 
It may be stated that in health short applications make little change 
in the bodily temperature. Temperatures here named, between 98° 
and 120° F., apply strictly to water, and not to other media, for the 
body may. under proper conditions, be submitted to superheated dry 
hot air at from 300° to 400° F. With water, very much higher tem- 
peratures can be borne where they are local. In the application of 
higher temperatures, 130° F. and above, a transient pallor of the 



PHYSIOLOGICAL ACTION OF WATER. 25 

skin takes place, accompanied by contraction of the smooth muscular 
fibers of the cutis, producing a goose skin effect. The sudden impact 
of very great heat may produce tremor and shivering. The increased 
temperature within and upon the skin results not alone in activity 
of the perspiratory glands, but the sebaceous glands are aroused to 
eliminate as well. The increased temperature of the body, it will 
thus be seen, results from heat conduction from the media into the 
tissues, and by the prevention of heat elimination. 

As thermic impressions rise above and fall below the "neutral" 
level, we find extremes meeting, a very hot and a very cold applica- 
tion being interpreted as pain. In practice the hydriatist takes ad- 
vantage of these temperature effects by first using a warm or hot 
application followed by a cool or cold one, in order that each may 
enhance the other. Where warm applications precede, cold is more 
acutely felt. When we have increased sufficiently the heat upon and 
within the skin and superficial tissues, cold rarely depresses, heat 
abstraction being prevented by the increased vascular, nervous and 
vital activities. 

Physiological Action of Cold on Temperature. 

Temperatures of water recognized as being cold commence at 92° 
and range between this figure and 34° F. Temperatures of 34° are 
borne by some few people, but the majority cannot, as a rule, stand 
45° F. Very much colder temperatures can be used in local applica- 
tion. The first effect of an application of cold water to the skin is 
a refrigeration, pallor and chilliness of the surface, accompanied by 
a contraction of the superficial small blood-vessels. 

Coincident with the contraction of the capillaries, the influx of 
blood into the skin is checked, through impressions made upon the 
sensory nerves and reflected along the vasoconstrictors. When con- 
traction of the small vessels takes place, the circulation is decidedly 
diminished, less opportunity is afforded for the elimination of heat 
from the skin, while reflex action stimulates and increases the devel- 
opment and production of heat within the body. 

It may be repeated that in healthy individuals taking an ordinary 
cold bath or hydriatic application, the heat loss is not demonstrable 
by the thermometer; if the bath is moderately long, and not very cold, 
the bodily temperature will remain constant, the balance between the 
heat loss and heat production being maintained by natural activities. 

Cold is essentially a depressant in its primary effect, but the forces 
of the body at once respond to prevent baleful influences and to resist 
its effects, both by the prevention of heat elimination and by in- 
creased heat production. There is a popular notion prevalent among 
the profession and laity that it is dangerous to apply cold to healthy 
persons while perspiring freely, for fear of reducing temperature. 



26 PRACTICAL HYDROTHERAPY. 

It is the experience of hydriatists that no harm, but good, results 
from such applications, provided the person is not at the time over- 
fatigued. The writer has frequently observed young men for this 
reason refusing to enter the water or swim until they have "cooled 
off." The application of cold water to the external surface may be 
used to lower internal as well as surface temperature. This loss is 
facilitated by the administration of friction, a fact utilized by Brand 
in his bath for the treatment of typhoid fever. Friction causes a dila- 
tation of the surface blood-vessels through its action upon the vaso- 
motor system. The dilated blood-vessels bring to the surface a larger 
volume of blood, favoring greater heat loss. Heat elimination is 
much more pronounced in febrile conditions than under normal and 
physiological ones. Winternitz has shown that heat elimination can 
be increased by friction 30 per cent., and that its application during 
the cold bath will prevent collapse. In febrile conditions the super- 
heated blood, brought to the surface by the friction, and in contact 
with the cold water, gives up its heat and re-enters the circulation 
considerably cooler. This has a direct effect upon the heat centers, 
especially the thermogenetic one, lessening the formation and favor- 
ing elimination. The intimate relation between the heat centers and 
the vasomotors enables the refreshed centers, struggling under febrile 
toxins, to better stimulate this center to dilate its peripheral blood- 
vessels and cause further heat loss. Here and elsewhere it must, 
however, be noted and never forgotten, that the use of cool or cold 
water in febrile states is not, as so firmly believed, to simply reduce 
temperature. While this does take place, still the important ele- 
ment is the rousing of the nervous system to battle against the in- 
vading host. This will be more clearly shown when we consider 
typhoid fever. Localized applications reduce the temperature of the 
part to which the cold is applied, but have no appreciable systemic 
effect. In some instances, continuous applications of cold to the head 
reduce general temperature by acting upon the heat centers of the 
brain, just as an ice bag, when applied over the heart, may produce 
the same effect, by cooling the blood and slowing the heart's action. 

Physiological Action Upon the Circulation. 

The circulatory system, comprising the heart and blood-vessels, 
may, from a general point of view, be divided into four divisions : 
( 1 ) The heart, acting as the propelling organ, or the vis a tergo, to 
the movement of the blood, distributing it to the different areas of 
the body, principally under the influence of the vasomotor system 
of nerves. These, in their turn, are influenced by all conditions 
within and without the economy — heat, cold, functional activity, 
emotions, nervous actions of various sorts, etc. (2) The arterial system, 
with three great areas that are of extreme interest to the hydriatist — 



PHYSIOLOGICAL ACTION OF WATER. 27 

the arteries of the skin, the arteries of the muscles, and those of the 
internal viscera, especially those supplied by the splanchnic nerves 
and commonly influencing portal circulation. (3) Capillaries, those 
minute intermediate blood-vessels between the arteries and veins. 
(4) The veins. 

All of these are influenced directly and indirectly by the appli- 
cation of varying temperatures to the external surface, especially the 
skin and muscular system. The quantity of blood in the human 
body is, within reasonable limits, fixed, and, ex necessitate rei, the 
production of an influx of blood into any one of the great physio- 
logical areas of the body (skin, muscles, viscera) acts as a depletent 
upon the others, and is a ready explanation of why a person may 
feel faint when suddenly entering into a hot room, or while taking 
treatment in a hot air or vapor bath. 

The Action of Heat Upon the Circulation. 

Placed in a warm or hot bath, or, for better illustration, in a hot 
air chamber or other heating method, the primary or immediate effect 
will be the sensation of heat. This is conveyed centrally by the sen- 
sory nerves, and produces a temporary or transient slowing of the 
pulse and heart's action, with an increased force of the former. 
Coincident with this, there may be noticed slight oppression of breath- 
ing, tightness and throbbing in the head, or faintness. The skin and, 
later, by conduction, the subcutaneous structures, begin to absorb 
heat from the surrounding warm medium, accompanied by the distinct 
sensation of increased surface warmth to the examining hand. After 
a variable time, by conduction, absorption and action upon the cu- 
taneous thermic nerves, the superficial blood-vessels dilate and the 
skin assumes a more pinkish hue, due to the increased amount of 
blood on the surface. The heart's action is noticeably increased, the 
pulse more rapid and smaller, and arterial tension lowered. The 
larger amount of blood upon the surface absorbs the heat that has 
entered the tissues, and, re-entering the general circulation, is carried 
to the medullary centers governing heat formation and dissipation, 
and which are in intimate association with the vasomotor, cardiac and 
respiratory centers. This heated blood quickens the response of the 
centers and causes the necessary changes to take place on the surface 
that will insure heat loss, the natural forces responding to the thermic 
stimuli in their endeavor to throw off or offset the effects, by heat loss 
from the dilated vascular surface, and by perspiration. The latter aids 
by the heat it removes and by evaporation — a distinctly cooling process. 
As we have seen, the temperature of the tissues is raised. If, instead of 
heated air, we employ water, the results are the same, save that, where 
mechanical stimulation, as in the douches, is superadded, the action is 
more rapid and pronounced. As soon as the surface dilatation takes 



28 PR.1CTIC.~IL HYDROTHERAPY. 

place, and the stream of blood is directed outward, the blood-vessels 
of the internal organs, because of the lessened amount of blood, and 
by reflex action, contract, thus bringing about a physiological anemia. 
Where heat is long continued, an atonic vascular state is induced, 
accompanied by more or less relaxation and enervation. 

Extreme heat or hot water applied to limited areas produces tem- 
porarily the same effects as extreme cold — local tissue and superficial 
blood vascular contraction, general rigor and the sensation of pain. 
A practical point in relation to the contraction of the internal blood- 
vessels of the brain is the use of cold to the head. This will main- 
tain vascular tone and prevent cerebral symptoms, faintness, oppres- 
sion, etc. 

The Action of Cold Upon the Circulation. 

The influence of cold upon the cutaneous surface is more decisive 
than that of heat, and, as has before been stated, is tonic in its action. 
This rapidity of action on the part of cold is one of its most inter- 
esting effects. Immediately following a general cold application, we 
find a refrigeration takes place, accompanied by pallor and contrac- 
tion. These changes are easily detected by touch and inspection. 
The skin becomes pale, somewhat shrunken, and the superficial blood- 
vessels contracted. The thermic nerves conveying the cutaneous im- 
pression of cold to the central nervous and sympathetic systems, 
transiently increase heart action and pulse rate, but where the appli- 
cation is brief — that is, tonic — it is almost immediately succeeded by 
a lessened frequency and stronger heart beat. The pulse is slowed 
and its volume notably increased, a fact easily demonstrable to the 
finger. Concomitantly the blood pressure rises, sometimes from 20 
to 40 m.m., as revealed by the Riva-Rocci sphygmanometer (broad 
band). My personal tests have shown that the peripheral tonic in- 
crease of circulation is due to the better blood pressure, and not to 
a weakened vascular state. Winternitz, Strasser, Baruch and Kellogg 2 
have made like observations, especially the latter. These results, physi- 
ologists tell us, arise from reflex action, which temporarily excites 
the accelerator nerves of the heart, later slowing its action through 
the pneumogastric. With the cessation of the application and reac- 
tion, the blood-vessels become slightly dilated, and more blood actu- 
ally circulates through the skin. This dilatation of the blood-vessels 
is tonic ; that is to say, there is a moderate contraction of the vessel 
walls, the result of the action of the inhibitory fibers and centers 
upon the vasomotors. The vasomotor mechanism of the body is 
most intimately concerned with the production of all these vascular 
changes, both in its periphery and centers located in spine and me- 



2 Kellogg, J. H. : "Rational Hydrotherapy,*' 1906; Baruch, Simon, "Hydrotherapy," 
1899; Winternitz, Win., "Die Ilydrotherapie auf physiolociecher und klinischer flrundlage," 
1890. 



PHYSIOLOGICAL ACTION OF WATER. 19 

dulla oblongata. These nerves run in the mixed spinal nerves, and 
are closely associated with the different sensations that arise normally 
at the periphery and usually recognized by afferent nerves. Again, 
we note that where the circulation is actively drained into a part 
there is a lessening of the quantity of blood in some other vascular 
region. This fact is utilized in practice, especially with reference 
to the action upon the abdominal blood-vessels supplied by the splanch- 
nic nerves, the dilatation of these blood-vessels producing vascular 
anemia in distant parts, or vice versa. These results are more quickly 
induced, lower temperatures better borne, and the effect longer con- 
tinued and more extended, where accompanied by mechanical stimu- 
lation, as in the various forms of douches. 

That the physiological action of external temperatures, applied 
to the skin and acting upon distant blood-vessels, is more particularly 
brought about through reflex action than by any other means, has been 
clearly demonstrated by Naumann in the following experiment : 

The head of a frog was separated from the body, being only con- 
nected by the medulla oblongata. He next severed one leg, after pre- 
venting the loss of blood by tying the vessels so as to leave it con- 
nected with the body by the sciatic nerve. He now applied thermal, 
chemical and electrical stimuli to the foot of the partially severed leg, 
while he observed under the microscope the mesentery. Shortly after 
gentle irritation of the peripheral endings of the sciatic nerve in the 
foot, the circulation in the vascular network of the lungs and mesen- 
tery was accelerated, and resumed the former condition slowly after 
the withdrawal of the irritant. Strong irritation of the skin weakened 
its circulation ; the feeble irritant strengthened it. As there was 
no possible vascular or nerve channel from the part irritated to the 
part thus visibly affected, the conclusion is inevitable that the effect 
was purely reflex. 

Maximilian Schuler 3 trephined rabbits, carefully exposing to view 
the vessels of the pia mater without disturbing the dura, which, by 
its transparency, facilitated his observation. He carefully noted the 
normal circulation of these vessels, and ascertained that even simple 
pressure upon the belly produced dilatation of the veins, and some- 
times also of the arteries, probably through mechanical interruption 
of the venous return flow. The most interesting observation, how- 
ever, was that when he placed cold wet compresses upon the belly of 
the rabbit, the vessels of the pia mater invariably dilated, cerebral pul- 
sation became more pronounced and slower, the respiration was deep- 
ened and slowed. When warm compresses were applied the arteries 
and veins of the pia mater contracted, the pulsation became less pro- 
nounced and more frequent, and respiration more shallow and rapid. 

3 Schueler, Maz: Deutsches Archiv. f. klinische Medicin, No. 4, 1874, XIV. Quoted 
by Baruch. 



30 PRACTICAL HYDROTHERAPY. 

Indeed, it may be regarded as proved that a causal connection cer- 
tainly exists between the various external applications of water and 
the typical changes in the vessels of the pia. 

Schiiller believes that "in the beginning of the application the pial 
vessels are affected by reflex irritation from the cutaneous nerves, 
and that the real effect upon the pial vessels occurs only when the 
thermic influence upon the cutaneous vessels has gained the ascen- 
dency. Local applications of cold to a limited area produce shrinking 
and shrivelling at the point of contact. Pallor accompanies this con- 
dition, due to a contraction of the blood-vessels and finer capillaries, 
especially their circular fibers, by means of which the blood is driven 
out. Long continued, a paralysis and dilatation of the blood-vessels 
occurs. It is axiomatic that prolonged cold depresses circulation and 
vitality, short applications act as a tonic. It is interesting to note, at 
this point, that the general vascular tone brought about by the appli- 
cation of cold to the surface more nearly resembles the healthy con- 
dition of blood vascular circulation than that induced by any other 
remedial measure. The heart may be slowed, its contractions made 
firmer, the pulse fuller, dyspnea, discomfort and precordial distress 
relieved by the cold compress, coil or ice-bag applied over the heart — 
that is, to the precordium. Winternitz has summed up its effects and 
action by the apt name he gave it, "the hydrotherapeutic digitalis." 
The alternate application of heat and cold to the cutaneous surface 
acts as battledoor and shuttlecock with the circulation ; heat dilating 
the superficial blood-vessels, increasing the heart's action, accelerating 
the pulse, lessening resistance and lowering arterial tension; cold 
contracting (tonically) the superficial blood-vessels, decreasing heart 
action, slowing the pulse and raising arterial tension. These circu- 
latory changes, following one another, influence the activity of dis- 
tant organs. Temperature, nerve and vascular effects are closely 
allied, and, as in heat production, so in blood vascular circulation, 
cold enhances the tone of the blood-vessel wall, while heat lowers it, 
although both may be followed by vascular dilatation, in the one in- 
stance tonic (cold), in the other, atonic (heat). It is because of the 
reflex action just above noted that clinicians utilize dermal thermic ap- 
plications for the production of special changes in the circulation, and 
by these means endow the different organs with increased and active 
function. The blood is the life of the individual and of the part; it 
is the great road upon which is conveyed nutriment to each and every 
tissue ; the highway upon which all waste products are removed from 
the various organs ; through the blood repair and growth take place ; 
it eliminates waste products and maintains health. It is thus evident 
upon reflection that he who controls in a measurable degree the circu- 
lation of the human body controls measurably all of its functions, 
all of its activity, and has within his grasp a means alike of preventing 



PHYSIOLOGICAL ACTION OF WATER. 31 

disease and of restoring health. The circulation is one of those flex- 
ible agents by means of which, in diseased conditions, medicaments 
are carried to their destination and function stimulated. Thus any 
agent that enhances or controls circulatory activity and distribution, 
influences and controls the absorption, distribution, action and activ- 
ity of any remedial medicinal agent used. One of the most satisfac- 
tory and valuable of all the effects of thermic applications to the 
periphery, is the fact that through its influence upon the vasomotor 
system the circulation and activity of far distant organs are materially 
changed. Thus, a congested or inflammatory condition of an internal 
viscus may be relieved not only by the suction-like process of drawing 
blood to the surface, or by the increased pressure of the blood behind 
forcing it out of the congested organ, but also by the increase of its 
circulatory activity, carrying to it restorative pabulum, by means of 
which it may regain its normal structure or may manufacture again 
its normal secretion. 

Physiological Action Upon Respiration. 

The main object of the respiratory process is to supply the system 
with the oxygen necessary for oxidative purposes within the economy. 
Respiratory function is carried on through the action of the lungs 
and skin. The mechanism consists of the alternate dilatation (inspi- 
ration) and contraction (expiration) of the chest wall, the movement 
being dependent upon muscular structures attached to the chest walls, 
together with certain additional muscular structures that may be 
brought into play under unusual circumstances. The average number of 
respirations ranges from 16 to 18 per minute, and bears the ratio 
to the pulse of one to four. The inspired air converts the dark venous 
blood, carrying reduced hemoglobin (Hb) to bright arterial blood 
(Hb0 2 ), the former giving up its carbon dioxide and substituting 
in its place oxygen, held in loose combination. The skin likewise 
loses CO, and gains O by diffusion of gases. The function of respi- 
ration is presided over by a nervous mechanism, and thermic im- 
pressions influence respiration by stimuli reaching it through reflex 
nervous impulses. Peripheral impressions may deepen or weaken 
respiratory action. The intimate and close relationship, both struc- 
turally, by nerve connection and function, between Ihe cardiac and 
respiratory systems, is such that any impressions acting upon one may 
result in influencing both. 

Impulses are conveyed to the respiratory center in the medulla 
through the nerves of common sensation by way of the spinal cord, 
are there correlated and reflected to the agent directly concerned in 
the respiratory act, the lungs. The respiratory center may be influ- 
enced by thermic impressions applied to limited areas, as is seen by 



32 PRACTICAL HYDROTHERAPY. 

the deep inspiration that takes place when cold water is applied to the 
face of a person who has fainted. 

The Action of Heat Upon Respiration. 

The immediate effect of a sudden general or local application of 
heat or hot water upon the respiratory function is a deep gasping, 
jerky and irregular inspiration, lasting for a few seconds, accom- 
panied by a sense of constriction in the chest, slight oppression, and 
succeeded by a well-marked increase in the number of respirations, 
which are, however, much shallower in depth. This increase is very 
variable, so far as my personal observations are concerned. These 
effects, primary in character, are due solely to reflex action, resulting 
from the thermic stimuli upon the surface, but when the individual's 
responsive power comes into play they may rapidly diminish. Another 
factor is then added. As the temperature of the surface and surface 
tissues rises the blood absorbs heat, is conyeyed to and bathes the 
medullary center, and by its irritation maintains an increased respira- 
tory action, of, however, a more steady, regular and equable character. 
By the increased respiratory action, some heat and considerable vapor 
are lost. These stimuli, remaining within physiological bounds, aug- 
ment the accelerator action of the center, but, where they become too 
powerful, may act as inhibitory factors by influencing the pneumo- 
gastric. 

There is very little contraction, and, after a short period, consid- 
erable relaxation, of all the muscular structures concerned in respi- 
ration- — a characteristic action of heat upon these tissues. Mechan- 
ical stimulation accompanying the application may more quickly pro- 
duce these changes. The more rapid and shallower respiration is 
not conducive to better absorption of oxygen and the elimination of 
carbon dioxide, but is, on the contrary, an endeavor on nature's part 
to by rapidity make up the necessarily diminished intake, the result 
of its shallowness ; hence we find the exchange and diffusion of 
gases lessened. Should the respiration become more adapted to the 
changed and heated surroundings, just in proportion will the gaseous 
exchange be increased. My personal observation has been that depth 
of inspiration is the essential factor. It may be said, in conclusion, 
that both factors reinforce one another, the one reflex, the other 
the bathing of the center in superheated blood. 

The Action of Cold Upon Respiration. 

As in the case of heat, so with cold or cold baths, general or local 
applications produce immediate spasmodic and interrupted respira- 
tion, frequently accompanied by a sense of strangulation. These last 
a variable length of time, from a few seconds to minutes if the bath 



PHYSIOLOGICAL ACTION OF WATER. 33 

is continued, at which time the system adapts itself to the changed 
conditions, and a more steady, equable movement results. 

The irregular breathing is due to the more or less spasmodic action 
of the ordinary and extraordinary muscles of respiration, especially 
the diaphragm. This muscle oftentimes contracts to such an extent 
as to "cut off the wind," an exceedingly disagreeable sensation. Con- 
traction of the abdominal wall muscles and the adduction of the arms 
to the chest walls frequently occur at this time. These effects may 
be readily produced by local cold applied to the chest walls and ab- 
domen. In moderate degree I have observed them from an ice-bag 
placed over the precordium. During this time the intake of oxyge;i 
and the output of C0 2 is lessened. These spasmodic effects result 
from the thermic irritation conveyed from the surface to the medulla, 
from there reflected upon the lung and chest muscles, as well as the 
direct effect of the cold application to the skin and muscular struc- 
tures of the chest and abdomen, being thus accentuated by a general 
and local action reinforcing one another. When the vital responses 
adapt themselves to the external irritation, the vascular stream sets 
in from the periphery and better supplies the medulla with arterial 
blood, lessening its irritability. With the cessation of the bath and 
the induction of reaction, respiratory action becomes slower, deeper and 
easier. There is a sensation as though the lungs had had a load lifted 
from them were broader and more capacious. For a considerable 
time thereafter the respirations are, by actual chest measurement, 
deeper, the chest expanding from one-half to one inch. This I have 
personally observed upon myself and other individuals, both sick and 
well. With the deeper, broader respirations, diffusion of gases takes 
place, and we find the oxygen content and C0 2 elimination markedly 
increased. Friedrich found this to be true when the naked body was 
exposed to cold air alone, especially the increased oxygen consumption. 
All these effects are enhanced if made abruptly and accompanied by 
mechanical stimulation, as in the douche, and are roughly propor- 
tional to the lowness of temperature. The wide systemic results that 
follow the addition of oxygen to the blood stream, the metabolic 
changes that follow, the added facility of elimination from better ox- 
idative processes, make this feature of hydriatics a most important 
and far-reaching one. The alternate application of heat and cold 
produces similar effects, but more pronounced. Reaction is more 
quickly favored. 

These physiological changes are induced by warm or hot water 
at much lower temperatures than where hot or superheated air is 
employed. Radiant energy or light acts more quickly and at lower 
temperatures, owing to its tissue penetrability, or transilluminating 
property. 



34 PRACTICAL HYDROTHERAPY. 

Physiological Action Upon Metabolism. 

By metabolism we mean all those intricate processes, physical, 
chemical and physiological, by which the human or animal economy 
brings about its tissue changes, anabolic or reconstructive, catabolic 
or destructive. 

The normal adult human maintains a metabolic equilibrium by 
the absorption and assimilation of food products and water from 
the digestive tract, and oxygen from the lungs ; appropriating these 
properly prepared pabula by his tissues, and removing from the sys- 
tem the end-products of tissue change through the excretory organs, 
and carbon dioxide from the lungs. 

When metabolism is equally balanced, the input is just sufficient 
and proper to meet all the demands of functional activity, repair all 
waste, furnish sufficient force and heat, the output of waste material 
being promptly and properly removed in toto. 

The great channel by which the pabulum is conveyed to the tissue, 
and the detritus removed from it, is the blood ; and, as we have here- 
tofore noted, this organ, in its circulatory activity, is greatly influ- 
enced by hydriatic procedures. Metabolism of tissue may be influenced 
by five means, as follows : 

1. Through the circulation ; an activity of function resulting from 
an increased quantity of blood flowing through the organ or part. 

2. Through the blood ; better composition, and in which the pres- 
ence of increased O stimulates oxidation and tissue change. 

3. Through blood-pressure; an increased blood-pressure causing 
more blood to pass through the capillary walls, and thereby favoring 
nutritive changes. 

4. Through temperature changes upon the tissues. 

5. Through the nervous system; especially the vasomotors in- 
creasing the circulation in a part; stimulation of trophic nerves, that 
increases the capacity of the tissues to absorb nutriment. 

To attempt to describe in detail the manifold and intricate nature 
of the changes that take place is foreign to this work, but the influ- 
ence of hydriatic procedures upon metabolism will be considered 
under four headings : 

1. Secretion. 

2. Absorption. 

3. Tissue change. 

4. Excretion. 

1. Secretion. — The importance of this function of metabolism can 
hardly be overrated. When we reflect that upon glandular structures 
the body depends for all those juices by means of which food is ren- 
dered soluble; for those more or less understood and appreciated in- 
ternal juices or secretions ; for lubrication and other functions ; we 



PHYSIOLOGICAL ACTION OF WATER. 35 

realize that, no matter where we turn, we find the glandular cell wait- 
ing to respond to stimuli. Nowhere in the broad range of physiology 
and pathology do we find such satisfactory returns for hydriatic intel- 
ligence as in this field, for chronic glandular disturbances are among 
the constant pictures before the clinician's eye. Study, reflection and 
observation have taught me the profound influence of hydrotherapy — 
heat and cold — upon these structures. In general terms it may be 
stated that brief applications of thermic stimuli, whether hot or cold, 
stimulate secretion, differing in degree rather than in toto; long- 
continued applications depress. 

This difference asserts itself, however, principally because it acts 
on the muscular fibers of these structures : that cold is tonic, heat 
atonic. I have repeatedly demonstrated the secretory stimulation of 
heat and cold applied to the salivary and hepatic cells. Very hot and 
very cold brief treatments resemble one another closely; between 
are all gradations. The marked accompanying influence of hydriatics 
upon the circulation furnishes the medium from which the aroused 
cells may select the pabulum to reconstruct their own tissues, if they 
be defective, and from which to make a better and freer secretion. 
Thus physiology clearly and simply answers the question why a crip- 
pled glandular organ does better work in the economy, regains its 
normal tone and activity, under hydriatics. General applications of 
heat and cold influence the general secretory functions of the body, 
while local effects may be obtained by concentrating upon certain 
organs and regions. Both general and local effects are enhanced by 
abruptness, as well as mechanical stimulation, when it accompanies 
the application. Among the noticeable general results of hydriatics 
may be mentioned increased appetite, greater relish and capacity for 
food — an important element in chronic cases. 

2. Absorption. — Without proper absorption, the pabula prepared 
by glandular organs would remain, and become useless to the body. 
Secretion and absorption are so intimate that what influences one cer- 
tainly influences the other. As we have seen, the better juices and 
better prepared foodstuffs resulting from glandular action are in 
shape for quicker and surer absorption ; and, as in the case of secre- 
tion, so with absorption, the more active blood-stream, the more ac- 
tive lymphatics and lacteals, take up the dissolved foodstuffs, and 
more rapidly and certainly distribute them to the tissues and organs. 
Nor does this stop with the alimentary canal. As we have seen, the 
respiratory activity being greater and the oxygen input larger, greater 
absorption of this living fire, oxidation, occurs, and the augmented 
quantities of it in the blood results in the better burning of waste ma- 
terials, just as a stronger draft in a chimney better consumes the coal. 
But there are still other absorbary processes that are equally impor- 
tant, and which respond quickly to hydriatics, these being the inter- 



36 PRACTICAL HYDROTHERAPY. 

and intra-cellular ones. Here the tissues absorb the new and better- 
prepared elements, giving up "old lamps for new," while the remain- 
ing surplus is better and more rapidly cared for by the lymphatics, 
because of the added muscular, glandular, nervous and circulatory 
influences. As in secretion, so in absorption, we secure the same ther- 
mic results ; general applications producing general, local ones, local 
results. Abruptness and mechanical stimulation enhance. "By intro- 
ducing belladonna into the rectum, and observing the length of time 
that elapsed before dilatation of the pupil, and other characteristic 
physiological effects, Fleury showed that absorption from the alimen- 
tary canal is very greatly accelerated by the cold douche. His ex- 
periment, and those of others, show clearly that cold applications to 
the surface stimulate absorption by the gastric and intestinal mucous 
membrane, and consequently that such applications must favor nutri- 
tion by promoting alimentation." 4 

The author has carefully studied clinically the influence of the 
hot, cold, and alternate hot and cold douche applied to spine and 
abdominal wall, and has observed greater absorption and activity from 
such measures, the scale showing a notable gain in weight, lasting 
often for months, and even years, after a course of hydriatics. 

3. Tissue Change. — Through the whole body functionation takes 
place, a breaking down into detritus, a building up or reconstruction 
of tissue. This broad law is applicable to every organ, tissue and 
function, and is, in its entirety, one of the most complicated of the 
many intricate activities of the marvelous human body. That this is 
best accomplished with an actively distributed circulation, under nor- 
mal pressure, high oxygen content and proper nerve force, no one 
will, I believe, deny. That normality of tissue action, ana- and kata- 
bolic, is promoted in health, and changed under pathological condi- 
tions, is so patent to any one who uses this agent that it is but a trite 
observation to make. 

YYinternitz has called attention to the fact that "when healthy 
persons who have for weeks displayed almost stationary weight, are 
subjected to heat abstraction once or several times daily, it will be 
observed that, if the other hygienic and dietetic conditions remain un- 
altered, especially the quale and quantum of the diet, a number of 
these persons will undergo a slight addition to their original weight, 
whilst the greater number will suffer a reduction of weight thereby." 

For the past fifteen years all cases coming under my personal ob- 
servation have been carefully studied with regard to the loss or gain 
of weight, under most varying conditions. I believe it to be true that 
both normal and pathological persons, as a rule, will remain stationary 
in weight, or reduce their weight, when their hygienic life and diet 
remain exactly the same. This we observe in treating the obese. 

4 Kellogg, J. H.: "Rational Hydrotherapy, 1 ' 1906, p. 121. 



PHYSIOLOGICAL ACTION OF WATER. 37 

On the other hand, we have observed that, oxidation, secretion and 
absorption being active, more food is taken, digested and absorbed. 
My experience with several thousand (three to four) cases has shown 
me that we can, by increasing the quantity or changing the quality of 
the food, regulate to a certain degree the gain of weight ; and, further- 
more, this gain will be of an entirely different character of tissue — 
stronger, more active and firmer to the touch. These changes are more 
prompt where the patient has been subjected to a heating method 
that stimulated diaphoresis, followed by brief tonic cold methods, me- 
chanical stimulation enhancing the effects, the process in its response 
bearing a relation to the capacity of the patient to respond to thermic 
and mechanical irritation. That the nervous system is the largest fac- 
tor in bringing about these changes cannot, I believe, be denied, for 
it is through this system that the internal visceral effects are produced 
by reflex action. As we shall see, the powerful effects upon muscular 
tissue aid the result, for bodily oxidative processes are intimately 
associated with muscular activity. 

Roehrig and Zuntz found "that changes in the intensity of tissue 
metamorphosis appeared to be traceable to certain cutaneous nerve 
fibrils which were excited by cold. These nerve fibrils could also be 
aroused by other stimuli, such as strong salt baths, with the same 
effect of increasing tissue change." 

An interesting point in connection with these experiments was that 
these increased oxidation processes seemed to be located in the mus- 
cles, through their nerve supply, and that the muscles need not, for 
this purpose, be aroused sufficiently to produce visible contractions. 
This was made evident by experiments made upon animals, in which 
the innervation of the muscles was placed in abeyance by arrow 
poison. In such animals tissue change was not only not increased by 
cold, but was reduced one-half. 

"They concluded that the source of tissue changes in the animal 
economy, when affected by cold, lies in the innervation of the mus- 
cles, and this is confirmed by the trite physiological fact that the larger 
part of all combustion processes occurring in the animal body may 
be traced to the muscles." (Baruch). 

Raising the body temperature by heat or hot water increases to 
a certain extent tissue changes, but is followed by an atonic state, 
from which the body slowly returns to the normal. Cold, per contra, 
is a direct and immediately stimulating measure, tonic in action. 
Alternate applications enhance one another as well as produce more 
permanent results. Mechanical stimulation augments the results. 
It may unhesitatingly be stated that the nutrition of those in health, 
and especially those diseased, is increased by the external application 
of heat and cold to the cutaneous surface. 

4. Excretion. — Without excretion death rapidly ensues; in fact, 



38 PRACTICAL HYDROTHERAPY 

the failure of certain of its various organs rapidly renders the individ- 
ual helpless, notably that of the lungs and kidney. Waste materials re- 
sult from bodily activity ; they are the ashes from the tissue fire. The 
principal organs involved are the kidneys, lungs, bowel, and second- 
arily the skin. This latter becomes more actively eliminant when any 
other function or organ is crippled. That the bowels may for years 
fail to properly remove waste material, is a common everyday obser- 
vation, and the organism seems to fairly well adapt itself to this 
state, although detrimental to health, comfort, and provocative of 
disease. Xot so with the lung or kidney ; their failure in great degree, 
even for short time, is likely to prove fatal. 

With the unusually increased pulmonary activity and exchange of 
gases we would have, as we have shown, a greatly augmented excre- 
tion from the lungs. This consists principally of C0 2 , although am- 
monia, extractives, etc., are present. In exchange for these waste 
noxious products, oxygen in large volume is absorbed into the blood, 
this with other factors permanently raising the hemoglobin. All 
bodily processes requiring oxygen are, therefore, bathed in this gas, 
and as a resultant the waste products of the body are made ready for 
exit. This increased oxidation ( and muscular activity ) may be used 
to consume a pathological excess of sugar in the blood, as in a dia- 
betes. That urea excretion rises under hydriatics I have demon- 
strated by hundreds of estimations. Formanek observed that after 
cold baths were given daily, so that a more decided abstraction of 
heat took place, the elimination of nitrogen in the urine increased 
markedly, and the excretion of uric acid generally kept pace with the 
excretion of nitrogen. In addition, a large number of extractives 
usually calculated as nitrogen sank after the bath period to 1.5 per 
cent., showing that the largest portion of the nitrogen was used up 
for the formation of the normal end-products of tissue change, thus 
leaving but a small portion for these extractives. 

The influence of cold procedures upon the urine may be readily 
studied by those who will take the trouble to estimate the specific 
gravity and urea of urine seven or eight hours after such a treatment. 
Strasser" found that the elimination of practically all waste products 
is increased after the cold bath. Xot only is urea and the urotoxic 
groups eliminated more freely, but we frequently find a diminution 
of uric acid, showing more perfect changes with increased oxidation. 
In addition to this, he found that there was an increased excretion of 
nitrogen, ''which must be ascribed directly to the increased activity 
of the organism, a more active change, due to a better utilization of 
the food. The promptness with which this effect occurred is evidence 
of this fact." Some recent studies by the author, in his private labora- 
tory, upon the specific gravity, urea, phosphates and purin bodies, 

5 Strasser: "Hydrotherapy," Cohen's Physiological Therapeutics, 1902. 



PHYSIOLOGICAL ACTION OF WATER. 39 

have shown a marked rise during the earlier baths (douches), followed 
later by a sinking, in many instances below the normal. I am fully 
satisfied that prompt and active elimination takes place from lung, 
kidney and skin, while clinical study has shown me remarkable biliary 
activity following both hot and cold methods. Especially is this true 
of short cold percussory applications over the liver regions, it not 
infrequently being followed by the so-called "bilious stool." Alternate 
applications, abruptness and mechanical stimulation are more decisive 
in their action. Heat or water measures, when used alone, do not 
produce all these effects, but, on the contrary, lessen the excretion of 
C0 2 and the absorption of O from the lungs, although increasing the 
terminal products in the urine. Cold not only augments the CO, 
elimination and O absorption, but brings about the changes we have 
described. Alternate applications enhance the actions here described, 
as does abruptness and mechanical stimulation. 

In conclusion, it may be said that heat applied to the surface of the 
body diminishes the excretion of C0 2 , lessens the absorption of O, 
and increases the elimination of waste products in the urine, while 
cold increases the elimination of CO,, increases the absorption of O, 
decreases the formation and increases the elimination of waste pro- 
ducts and toxic material through the kidney. While we have con- 
sidered metabolic changes separately, it must be remembered that each 
is but a part of the whole, a mosaic from which the removal of one 
stone will mar the beauty and perfection of the whole. 

Physiological Action Upon the Nervous System. 

The extensive area of the cutaneous surface of the human body 
is a "harp of a thousand strings," upon which the hydriatic master 
can play the gamut of impressions, so as to obtain almost any physio- 
logical or therapeutic response. To those who have carefully read the 
preceding section it will be plainly evident that in the consideration of 
the influence of thermic and mechanical procedures upon the skin and 
distant organs, in every instance the nervous system has been men- 
tioned as an active factor. Distant and internal results are entirely 
brought about through its dominating influence upon every structure 
and function of the human body. 

Cut off from its nerve supply, a tissue wastes ; in full possession 
of it, the part performs its function with regularity and normality. 
It has been truly remarked, "the cells are the artisans in the organic 
workshop, but the nerves are overseers." One can do no more than 
in a cursory and superficial way touch upon the influence of the 
nervous system with regard to thermic stimuli. A full knowledge of 
the minute anatomy and physiology of the nervous system is a pre- 
requisite to a thorough comprehension of hydrotherapeutic effects. 



40 PRACTICAL HYDROTHERAPY. 

The cerebrospinal nervous system consists of brain, medulla and 
basal ganglia, spinal cord and peripheral nerves. The peripheral 
nerves are spread in a vast network over the entire skin surface, are 
both efferent and afferent, carry common and special sensations to and 
from the skin to nerve centers located in the central nervous system. 
They are distributed to muscles, glands and other structures in the 
skin, to the large and small skeletal muscles, and intimately connected 
with one another. Each segment of the cord, the medulla, basal 
ganglia, and even the brain itself, are in close direct and reflex con- 
nection with each of these parts, and each with one another. From 
cord, medulla and brain pass the cranial and spinal nerves that govern 
and control all the tissues of the body. All of these segments and 
levels are in turn connected with the sympathetic nervous system in 
hundreds of ways. It is upon these peripheral sensory nerves that 
the hydriatist plays with his thermic and mechanical stimuli ; from 
their terminations myriads of impressions pass centripetally (inward) 
to the cord impressing its centers in the gray matter ; on and upward 
to the medulla and basal ganglia to, finally, terminate in the gray 
matter of the cortex. From these "levels," cord, base and cortex, 
each sends out its own "reflex" messages the result of the stimulation, 
so that all tissues, organs, structures and functions correlated to the 
level are made to feel the imprint of far distant sensory perturbations. 
Here, then, are the wires, here the messages, here the "overseers" 
that raise and lower, restrain or urge, stimulate and sedate ; here is 
the method by which far distant processes are brought in touch and 
their action harmonized. Were the peripheral sensory nerves removed 
the hydriatic response would be an unknown thing. But the human 
being is a sentient animal that responds accurately, surely and promptly 
to the master hand, and thus those changes at which so many marvel 
come to pass, even as the day succeeds the night. As we have here- 
tofore said, hydriatics produce perturbations of these sensory nerves, 
the impressions of which leave their imprint upon the central nervous 
system as well as upon the tissues controlled by it. 

Ably seconding the cerebro-spinal, is the sympathetic or ganglionic 
nervous system, consisting of a series of ganglia located in different 
portions of the body. A long chain, the intervertebral, extends from 
the upper cervical to the coccygeal region, lying on either side and 
between the vertebras. They are connected with one another and each 
other, and send filaments to the ganglia in the viscera. There are 
ganglia in the thorax, abdomen and pelvis, and subordinate ganglia 
in certain organs and tissues. The fibres from this system are dis- 
tributed to and follow the ramifications of the blood-vessels every- 
where, and are intimately associated with the control of vital activities. 
This "vegetative" system, especially the great ganglia in the interior 
of the trunk, receives impressions from the nerves distributed over the 



PHYSIOLOGICAL ACTION OF WATER. 41 

body and from the subordinate ganglia, rearranging and controlling 
them. 

It must be borne in mind how richly the corium is supplied with 
blood-vessels, therefore richly with sympathetic nerve fibers. These 
respond with great rapidity to thermic impressions. 

This system, then, has to look after principally the metabolic pro- 
cesses of the body — secretion, absorption, tissue change, excretion — 
and the circulatory activity that accompanies their function. While 
closely associated with the cerebro-spinal, it is not controlled by it. 
It may, by its action upon circulation, in its turn change the quantity 
of blood in the brain, and affect thereby mental activity and even 
consciousness itself. Under its beneficent influence the lungs, heart, 
liver, stomach, intestines, kidney and reproductive organs functionate. 
It is thus easy to see that through these marvelous and wonderful 
systems of nerves, the clinician may, by properly applying thermic 
and mechanical stimuli, so vary the normal and pathological pro- 
cesses of the body as to enhance the former and correct the latter. 
He can dominate the circulation, change nutrition, increase or decrease 
function, and even change the current of thought. Here, then, lies a 
method open to all, that may, through its action upon the nervous 
system, be made to reach the foundations of life itself. Within the 
nerve tissue itself the "neurons," or nerve cells, carry on this work. 
They consist of a neuron body, from which project wedge-like pro- 
cesses, the dendrites ; a neuraxon or nerve fiber, "end-brushes"' or 
contacts and telodendrons or end-plates. These cellular structures are 
in relation with, are superimposed in groups above and around one 
another. A number of years ago Waldemeyer noticed that the "end- 
brushes" moved, were attached and detached, and si'nee his commu- 
nication we have seemed to have a clearer idea of this complicated 
problem. It is now held, with some dissent, that the neuron is a 
distinct and separate entity, influenced, like all other cellular structures 
of the body, and being capable of projection and retraction. It is by 
means of these movements that we are able to form a rational ex-. 
planation of varying nervous phenomena. 

That the neurons are similar in action to protoplasmic bodies we 
can hardly doubt. We know full well the action of heat and cold upon 
the white blood cell and ameba, the former increasing, the latter 
decreasing movement, so we can believe that the movements of the 
dendrites would be likewise affected. Thus would be explained the 
exciting effects of heat by increased movements of the dendrites, the 
reverse in the case of cold. 

The Action of Heat Upon the Nervous System. 

When the body is surrounded by a medium higher in temperature 
the sensory nerves convey the thermic impressions from the periphery 



42 PRACTICAL HYDROTHERAPY. 

to the centers in the cord, medulla and brain. Speaking in general 
terms, it may be said that the appreciation by the nervous system of 
heat is slow as compared to cold, the rapidity of heat response being, 
of course, proportional to the rise of the temperature above the body 
heat. Heat in its primary action upon the nervous system is that of a 
stimulant, or even excitant, according to its degree and duration. After 
a variable state the superheated vascular stream coming from the 
surface where the blood has absorbed heat bathes all nerve tissue, so 
that the organism and its force rise to meet and throw off or nullify 
the influences that are acting upon the surface. Heat loss is now 
encouraged by the increased surface vascularity and perspiration. 
Even under proper adjustment and heat loss to balance the rise in 
temperature, we find that there remain in the tissues, and especially 
the nervous system itself, waste materials and toxins that have a 
depressing effect — in fact, are fatigue poisons. Relaxation in general, 
and a debilitating feeling in particular, the result of heat's own ac- 
tion on nerve tissue, results, the individual feeling a sense of lassi- 
tude proportional to his sensitiveness to heat and the duration of the 
exposure. That some of these effects are due to the action of heat 
upon cerebral tissue is shown by the fact that cold to the head will, 
in nearly all cases, prevent these unpleasant cerebral symptoms and 
enable the body to be longer exposed to higher temperatures. The 
peripheral nerves themselves become sensitive or acute, responding bet- 
ter to stimuli than under ordinary circumstances. The spinal cord, 
medulla and basal ganglia are more reflexly active. Owing to the 
attempt to prevent heat formation, the oxidative processes of the body 
are lessened, waste materials accumulate and by their presence oppress, 
excite, and add to the lack of vitality. All these effects are more 
rapidly produced where hot air is inhaled ; from hot air quicker 
than water, and still faster from radiant energy that penetrates 
tissue. 

The neutral line — temperatures between 92° and 96° F. — pro- 
duces an action due to its very negativeness. It possesses no thermic 
properties, therefore the essential feature of peripheral nerve pertur- 
bation is absent. The peripheral nerve terminations, bathed in a fluid 
that renders them softer, and hence less conductive, free from thermic 
stimuli from the water, the usual atmospheric and other cutaneous 
irritations shut off, become, from the very absence of external activ- 
ity, calm and quiet. Unable to eliminate by perspiration, the skin 
becomes moister, more succulent and less sensitive, from its own con- 
tained water. Restlessness, irritability, nervousness and excitement 
are so diminished as to almost insure prompt sedation. In Strumpell's 
celebrated case, where the only avenues of communication were one 
eye and one ear, the shutting of one and the closure of the other 
shortly induced sleep, owing to lack of excitation. It is in a similar 



PHYSIOLOGICAL ACTION OF WATER. 43 

manner that neutral temperatures exercise their characteristic action 
of sedation, the result of an absence of peripheral stimulation. 

The Action of Cold Upon the Nervous System. 

Cold, per contra, in its action is quick and decisive. Almost coin- 
cident with its striking the skin its disagreeable (to most people) 
impression is carried centripetally, rousing the centers of the cord, 
medulla and brain. How noticeable is the effect of a dash of cold 
water upon the face of a fainting person, the rousing effect of cold 
water in the lethargy of alcoholism ! It is often ten, twenty, a hun- 
dred times more rapid than heat. Brief cold applications are essen- 
tially tonic in action, probably more nearly an actual tonic to nerve 
and general tissue than any other medicament or method. The first 
effect, as I have said, is disagreeable, uncomfortable, accompanied 
probably by rigor and gasping. If the duration is brief, reaction, a 
true nervous phenomenon, takes place, followed by all the pleasant 
sensations to be hereafter described. The cutaneous perturbations 
set up by cold reach the cord, medulla, basal ganglia and brain, the 
ganglia and nerves of the sympathetic system, and start in action the 
thousand and one effects we have heretofore described, and which 
influence temperature, circulation, respiration, metabolism, muscular 
tissue, etc. That these results are due to nerve action alone, we 
again quote that experiment where Naumann separated all the parts 
of the posterior extremity of a frog, so that the limb remained at- 
tached to the body by the sciatic nerve. He then applied cold to 
the leg, and observed that if the cold were moderate there was a dimi- 
nution in the capillary circulation of the mesentery, but when the appli- 
cation of the cold was prolonged there was a dilatation of the vessels. 

Upon mentality, a brief application of cold to the head or face re- 
sults in increased cerebral activity, as does a general tonic bath, more 
noticeable where we employ percussive measures, as in the douche. 
Prolonged local cold to the head, as well as to the body, results in a 
lessening of mental activity, a drowsiness, an incapability for cere- 
bration, often noted by those who are lost in snow storms or long 
exposed. The author has personally experienced this numbing effect. 
There can be no denial of the fact that the frequent use of general 
tonic cold baths results in a more active mentality. Mental action 
may be stimulated and more work accomplished by certain local baths. 
The author has repeatedly demonstrated on his own person, clini- 
cally, the increased cerebral activity that follows the cool or cold 
sitz bath. 

The functions of the spinal cord are much increased by cold appli- 
cations, especially those that govern nutritive processes. Upon the 
peripheral nerves heat renders them more acute, as we have noted ; 
cold, on the contrary, blunting sensation. This is true of the tactile, 



44 PRACTICAL HYDROTHERAPY. 

pain and other sensations present in the skin, and to a certain extent 
it affects the nerve terminations in the muscles, for we have all re- 
marked how clumsy is the cold hand. Pain may be abolished by very 
low temperatures, freezing by the rhigolene spray being formerly 
much employed in minor surgery. A gradual contact is more plainly 
felt than an abrupt one, just as a finer spray feels colder than a coarse 
one, the percussion of the heavier body of water dulling sensation. 
Reactions from these effects are, however, quicker under percussion 
effects. 

Local applications of heat and cold can be borne at temperatures 
much higher and lower than where they are general. Certain re- 
sponses, at different parts of the body, may be elicited through re- 
flex action, because of a correlation between the surface skin and 
deeper seated tissues and organs. Alternate applications of heat and 
cold, or heat followed by cold, may be summarized as an accentuation 
of both their physiological effects upon the nervous system, and should 
always have cold at the last because of its powerful tonic effects. 
Both are augmented where mechanical stimulation accompanies the 
thermic irritation. Clinical observation and study in health and in 
diseased states accompanied by a lowering of vitality, lessening of 
nerve energy, a retention of waste products, failure of elimination 
and fag. show that the alternate application of heat and cold, together 
with suitable diet and rest, form one of the most satisfactory means 
of dealing with these conditions. 

Physiological Action Upon the Muscular System. 

The muscles form one of the most extensive systems of the body, 
and a large part of the body weight, especially the striated skeletal 
ones attached to the bony framework for the purposes of movement 
and to subserve the needs of bodily activity. Intermediate is the 
heart, uterus, etc., and then the important group of non-striated fibers 
that are found in glands, blood-vessels and other important organs 
and tissues of the body. All muscular movement is dependent upon 
its nerve supply for activity, so that there is a close and intimate 
relation between nervous and muscular activity. The interruption of 
nerve connection means muscular inactivity and subsequent atrophy. 
Muscles are richly supplied with blood-vessels, which become dilated 
during movement and draw into them large quantities of blood. Thus, 
in a moving muscle there is more blood, more oxygen is consumed, 
more carbon dioxide given off, the process causing destruction of 
muscular proteid, increased urea formation and the production of 
heat. 

It is believed that the source of most muscular energy is derived 
from the carbohydrates. This is stored Hp in the muscles during 
rest under the form of glycogen, and consumed by muscular work. 




Plate 12 — Normal Fatigue Curve of Man Aged Twenty-four Years (Kellogg). 



Plate 13— Fatigue Curve of the Same Subject After a Hot Bath (Kellogg). 



PHYSIOLOGICAL ACTION OF WATER. 45 

While it is true that this class of foods furnishes the major part of 
energy, still some is undoubtedly derived from proteid material. Mus- 
cular tissue possesses the property of contraction, and this can be 
produced by numerous stimuli applied directly to it or acting upon 
its nerve supply. Muscular activity or contraction is essential to 
well-being and health. Sedentary states are provocative of certain 
diseases. 

When muscular structures have been used for some length of time 
they become fatigued ; that is to say, there collects in the muscle 
tissue waste products which prevent its proper energizing. The ques- 
tion of fatigue is largely determined by the metabolism that takes place 
in the muscles. It may be relieved by an influx of fresh arterial blood 
— a fact that the Sandwich Islanders take advantage of by applying 
massage to one of their number should he give out while in swimming. 

This explains how fatigue is overcome by hydrotherapy, whether 
it be the result of neuro-muscular activity within physiological limits, 
or pathological fatigue, as in neurasthenia. 

We are able to state positively, through the curves shown by 
Mosso's ergograph, that hydriatic applications influence muscular 
structures. 

The Action of Heat Upon the Muscular System. 

Heat or hot water applications may affect skeletal muscular tissue 
in two ways : First, by reflex influences due to the surface thermic 
irritation ; and secondly, by actual heat conduction through the skin 
and cellular tissues to the muscles themselves. Non-striated and 
other muscular tissues depend upon the first alone. Muscles gradually 
respond to warm or hot applications, relaxing. The blood circulation 
is greater, metabolism increased, and excitability and capacity for 
work diminished. This is readily appreciated by those who have 
experienced the enervating effects of prolonged summer heat, which 
so reduces physical and mental activity. Where hot applications alone 
are used, the individual remains for some time relaxed and enervated, 
gradually returning to the normal. With very hot baths there is a 
difference; they are distinctly stimulating. The cleanly Japanese 
have for a long time used these baths, of short duration, at tempera- 
tures which the Occidental skin would hardly deem possible of stand- 
ing, finding in them a means of stimulation and revivification, over- 
coming fatigue and its incident depression. They resemble very 
cold baths in this respect. Thus the Jap and John Bull use different 
methods, but arrive at the same results. 

Very hot baths may be, therefore, used in cases where the vitality 
i s ] ow — in fact, are to be preferred, as the neural response to cold is 
poor. These baths relax, sedate, remove waste fatigue poisons, as 
well as stimulate. Very hot local applications produce a temporary 



46 PRACTICAL HYDROTHERAPY. 

pallor, rigor, contraction of blood-vessels, goose skin, some pain, fol- 
lowed almost immediately by redness, relaxation, dilated blood-vessels 
and comfort. Muscular twitching, spasm, pain due to contraction, 
to lessened blood supply or nerve irritability are relieved by their use. 
YVe have already noted heat's action upon the heart. The relaxing 
and depressing effects of prolonged heat can be relieved by a cold 
application. Mechanical stimulation accentuates these effects. 

The Action of Cold Upon the Muscular System. 

The first effect of cold upon the muscular structures of the body 
is a general rigor, associated with a contraction of the muscular fibers 
of the skin, causing cutis anserina, or the so-called "goose skin." The 
muscles of the chest and abdomen contract, producing gasping res- 
pirations. Pallor of the skin is present, due to contraction of the 
circular muscular fibers of the blood-vessels, driving out the blood. 
This irritability lasts for a short time ; where the applications are 
long-continued, lessened muscular irritability and energy result, fol- 
lowed by lassitude and inactivity. Internal effects upon the muscu- 
lar structures of organs and far distant tissues are entirely through 
nerve action. Cold may act in a reflex manner and cause muscular 
structures of the internal viscera to contract, as is frequently evi- 
denced by the fact that a general cold, or even a local application, may 
produce evacuation of the bladder. It is a common clinical observa- 
tion that cold to the general cutaneous or abdominal surface causes 
contraction and stimulation of the muscular structures of the intes- 
tine, increasing assimilation, overcoming atony and constipation by 
its action upon their muscular tissue. 

Mosso, by means of his ergograph, has shown, in a series of mas- 
terly studies, the action of cold upon muscles, as have Vinag and 
Maggiora. 

The tracings here shown exhibit in graphic manner the increase of 
power under cold water. It is a true tonicity of tissue, with increase 
of power. Kellogg calls attention to the interesting fact that cold 
may lessen the irritability of voluntary muscles and increase the 
activity of the smooth fibers, thus giving rise to the appearance of 
goose skin. Muscular activity may be increased one-third, or even 
more, which is so well known at the present time that it is utilized by 
athletes the world over. No prize-fighter would think of entering 
the squared arena without his cold shower and rub down. Mechanical 
stimulation or percussion, added to the temperature effects, as in the 
jet douche, make it probably the most powerful tonic stimulant to 
these tissues now known. Clinical observations and personal experi- 
ence but tend to confirm what these investigators have experimentally 
determined. Here, again, a heating procedure, followed by a brief 

Blaetter £. klinische Medicin, 1892, Vol. II, No. 1. and Vol. Ill, No. 7. 




(3) 





(4) 



Plate 14— (1) Normal Fatigue Curve, Left Hand; (2) Normal Fatisrue Curve 
Right Hand; (3) Fatigue Curve, Right Hand, after Bath 50° F for Fifteen 
Seconds; (4) Fatigue Curves after Gradually Cooled Bath (from Baruch). 



PHYSIOLOGICAL ACTION OF WATER. 47 

cold bath — that is, an alternation of the two — shows that they rein- 
force one another's responses. Hydriatics is the method beyond ques- 
tion for the over-strained and tired worker of to-day, as well as for 
the pathologically fatigued neurasthenic. 

Physiological Action Upon the Blood. 

The blood is a complex fluid, the composition of which varies con- 
siderably in health, and markedly in disease. It contains all the ele- 
ments essential for the growth, repair and functionation of tissues 
and organs, is the life of the body, and its failure to reach any atom 
means its death and decay. It receives its reconstructive pabula from 
the digested and soluble food of the stomach and intestines, its fluidity 
from the water ingested, and oxygen from the lungs. It carries all 
these, as we have seen, to the tissues, bathes them in it, and allows 
of specific selection of needed elements. It in turn becomes a cloaca 
from which refuse detritus is removed to the organs of elimination. 
It consists of the plasma, or fluid element, and corpuscles, both red 
and white. The red cells are engaged principally in supplying the 
tissues with oxygen, which is brought to them in a loosely combined 
state as oxy-hemoglobin (Hb0 2 ), and which is exchanged for CO,, 
reducing the hemoglobin to its venous state (Hb). The white cells are 
reparative agents, are the "soldiers of the common good," that as 
phagocytes fight invading bacterial hosts and toxins, or furnish op- 
sonins, that render the bacteria less resistent to their action and 
raise the "index" of vitality. Winternitz 7 many years ago, and later, 
called attention to the fact that hydriatic procedures caused an increase 
in the white and red blood cells, especially the former, accompanied 
by an augmented hemoglobin content. The author 8 has in a recent 
article embodied a number of experiments made by him with a view 
to confirm the foregoing statements. It may be said that hydriatic 
applications increase the number and activity of the corpuscular ele- 
ments as well as the amount of hemoglobin present. This, however, 
is not due alone to increased formation of cells, which does occur, but 
to vast numbers of these bodies which were lying dormant in the in- 
ternal viscera, long bones, etc., and which were pushed into and taken 
up by the more active blood stream. That the quality and quantity of 
the blood are improved by hydriatics is a logical sequitur of what has 
gone before. Improvement of circulation, better secretion, and its 
inevitable improvement of digestion ; more active absorption, hence 
quicker utilization of foodstuffs; more perfect assimilation and tissue 
exchange ; rapid removal by the excretory organs, would mean more 

7 Winternitz, Wm. : "Changes in the Blood Resulting from Application of Heat and 
Cold." Translation, Modern Medicine and Bacteriological Review, December 1893. 

8 Pope, Curran: New York Medical Journal, 1907, "Treatment of Anemia and Chloro- 
sis," and read before the Kentucky State Medical Society, 1907. 



48 PRACTICAL HYDROTHERAPY. 

blood, better blood, cleaner blood ; blood that has high oxygen-absorb- 
ing and distributing powers ; a blood to reconstruct and heal tissue ; 
blood whose phagocytes and opsonins are ready, cap-a-pie, for the in- 
vading hosts. It is the kind of blood the healthy, as well as the sick, 
need for the preservation as well as restoration of health. 

The Action of Heat Upon the Blood. 

Local heat of short duration vitalizes the white corpuscular ele- 
ments of the blood and increases greatly their activity. These flock 
in large numbers to any point where a limited hot or very hot appli- 
cation has been made. This is very noticeable after the local use of 
the high temperatures employed in superheated dry hot air. The 
number of red cells locally is diminished, as well as their hemoglobin 
content and oxidizing power. With the large number of leucocytes, 
phagocytosis and opsonic index, as shown by Metchnikoff, 9 is raised. 
High temperatures of long duration weaken and destroy these cells. 
This is one of the dangers of fevers. General applications diminish 
the number of both red and white cells, due, as Winternitz says, to 
their retention in the viscera. For this reason the hemoglobin is also 
lessened. Strasser 10 has found that general applications of heat de- 
crease the alkalinity of the blood by the presence of an added amount 
of acid phosphate. He further observed a marked diminution in 
the density — that is, the fluidity — under heat. It therefore follows 
that we have a more acid and thickened blood stream, due, in my opin- 
ion, to a lessened quantity of liquid element. 

The Action of Cold Upon the Blood. 

General and local applications of cold increase the corpuscular 
elements, but the white are proportionately increased over the red. 
This is true in a physiological response, and equally so in fevers, 
Thayer 11 having demonstrated a large increase after the cold bath used 
in typhoid. With the increased white cells we may expect better 
phagocytes and opsonic activity, repair of tissue and healing. The 
greater number of reds, the larger hemoglobin-carrying power, mean 
redder and richer blood of greater oxidative powers, a stream capable 
of ridding itself of waste material and toxins. In the same studies, 
Strasser {vide above) demonstrated a marked increase of alkalinity 
of the blood, due to diminished acid phosphate, sometimes as much 
as 50 per cent., together with lessened density, although the actual 
number of cells was increased. This means a more fluid blood. As 
a natural corollary we may say that the blood is not alone freed from 
impurities, but those groups which we may as we please call "uric 

9 Metchnikoff. E. : "The New Hygiene." 1907. p. 22. 

10 Strasser, Alois: Deutches medizinische Zeitschrift, June 15. 1896. 

11 Thayer, Wm. : Johns Hopkins Bulletin, 1893, Vol. IV, p. 37. 



PHYSIOLOGICAL ACTION OF WATER. 49 

acid" or purins, or the urotoxic group, toxins and impurities of tissue, 
are destroyed and removed from the body, via the eliminative organs, 
without the intervention of chemicals. The alternate or the primary 
use of heat, followed by cold, secures all the advantages of both appli- 
cations, the one supplementing the other, and both enhanced where 
mechanical stimulation is superadded. It should never be forgotten 
that hand in hand with these changes is a circulation evenly and prop- 
erly distributed to all parts of the body under a stable and normally 
acting nervous system. When thus purified, it fulfills literally the 
proclamation of Holy Writ, "The blood is the life." 

The Hydrotherapeutic Reaction. 

Upon numerous occasions reaction has been spoken of, and it 
now remains to be considered in detail. The hydrotherapeutic reaction 
is a response of the vital activities of the body to thermic and mechan- 
ical stimuli of varying degree applied to the cutaneous surface. It 
is the antithesis of the actions produced by heat and cold. It is a com- 
plicated process, many-sided, but manifested principally along thermic, 
circulatory and neural lines. The varying stimuli applied to the cu- 
taneous surface produce a primary or immediate result that is followed 
by secondary changes or reactions. 

General reactive responses (cold) are coextensive with the struc- 
tures of the body, every cell and tissue, every structure and function, 
feeling its influence. In order to have the reaction it is essential to 
have some thermic deviation above or below the neutral zone. Tem- 
peratures between 92° and 96° F., strictly neutral, are rarely, if ever, 
accompanied by mechanical stimulation, so that their action is purely 
a temperature one. A bath that is essentially neutral checks the stim- 
ulation of vital phenomena, and reaction is the result of a stimulating 
process. Neutral temperatures, it may again be remarked, are in 
their action quieting, nerve-obtunding and calmative to nervous action, 
and it is through nervous response that these manifestations are 
brought about. The reactions associated with heat are not, as a rule, 
sought, but are more or less depressive, relaxing and atonic in char- 
acter. The action of heat has been previously considered, and the 
atonic responses are best understood by grouping them in a table, as 
has been done by Kellogg. 12 

Heat. 
ACTION. REACTION. 

1. Brief contraction, then dilatation 1. Vasoconstriction, 
of the surface blood-vessels, especially 
of the small veins. 

2. Slight pallor if previously red, 2. Pallor, 
followed by dusky redness. 

12 Kellogg, J. H.: "Rational Hydrotherapy," 1906, p. 121. 

V 



k 



50 PRACTICAL HYDROTHERAPY. 

3. Sometimes goose flesh appearance 3. Skin smooth, soft and moist, 
and slight shivering. 

4. Slowed, then quickened high- 4. Pulse frequent, tension low. 
tension pulse. 

5. Respiration, at first checked, then 5. Respiration frequent, free, super- 
frequent ; CO2 diminished. ficial. 

6. Perspiration, at first checked, 6. Respiration lessened, 
then increased. 

7. Heating of the skin. 7. Gradual cooling of the skin. 

8. Rise in internal temperature, 8. Depression of internal tempera- 
from diminished heat elimination. ture from increased heat elimination 

and decreased heat production. 

9. General nervous excitation; at 9. Diminished nervous and mental 
moderate temperature, sense of com- irritability, drowsiness and depression, 
fort and relief. 

10. Increased muscular irritability. 10. Muscular weakness and indispo- 

sition to muscular effort. 

It will be observed that the reactive results show a general atonic 
state, lack of nerve tone and muscular activity. 

Cold, however, is, par excellence, the agent by which we produce 
the well-known effects of reaction. In studying reaction we must 
remember the primary effects of cold upon the periphery ; the gasping 
respiration, refrigeration, pallor, cutis anserina, contracted blood- 
vessels, rapid pulse, dilatation of internal blood-vessels and nervous 
shock (physiological). With the cessation of the cold or withdrawal 
from the bath there ensues a feeling of warmth in the skin ; it loses 
its pallor and assumes a reddish hue. Under the hand or when friction 
is applied it quickly "pinks" up, or becomes red. The goose flesh 
rapidly subsides, and the skin may feel warm to the touch, though 
rarely so. The blood-vessels that were contracted now dilate, not so 
much as under heat, but assume a median position between heat and 
cold — the "tonic" contraction, "probably due to an excitation of the 
inhibitory nerves, which overcome the action of the vasoconstrictors" 
(Baruch). This dilatation continues for some length of time after 
the bath, and is the standard for a normal skin circulation. Accom- 
panying this is a sense of glow or warmth, exceedingly pleasant to 
feel ; once experienced it is sought again. The internal blood-vessels 
are moderately contracted, owing to the greater quantity of blood in 
the superficial blood-vessels. The heart's action becomes slower and 
better, its sounds clearer, the. pulse fuller and less rapid, and arterial 
tension is raised. The glandular activity of the skin is increased, the 
skin is moister and perspiration is present. For this reason the indi- 
vidual should be protected by a sheet until dressed. Respiration is 
broader, deeper and freer, more oxygen absorbed, greater C0 2 elim- 
inated, while the chest walls and lungs feel as though there was greater 
freedom of action. The muscles possess greater tone, and there is 
the feeling of greater power for muscular effort. Possibly some 



PHYSIOLOGICAL ACTION OF WATER. 51 

metabolic changes take place during this short period, enhancing the 
sense of well-being. There is often a sensation of tingling felt in the 
skin, due to the thermic and mechanical action upon the peripheral 
nerves. Pain is lessened, sensation acute. There is a bodily vigor and 
tone, probably due to spinal action. The mental faculties become more 
active, there is an increased capacity for work, fogginess is cleared 
away and mental clearness succeeds. This general feeling, best de- 
scribed as a bein faisance, or well-being, is one of the most delightful 
and pleasant of the neural effects of reaction. The aim being to secure 
reaction, care should be taken to study what will favor this result 
before, during and after the bath. For this reason fatigued persons 
should be carefully handled and rested before taking treatment. It 
may be taken as axiomatic that the stronger and more robust the 
physique the better the reaction ; especially is this true when persons 
have been accustomed to the use of cold water as a daily procedure. 

Warmth, both of body and the bath-room, is a necessity, and this 
may be secured by any number of measures. In strong persons 
muscular activity before the bath favors reaction ; in weak ones, rub- 
bing or friction, a hot enema, hot-water drinking, hot-air bath, or, 
what is by far the best, the incandescent electric light bath, stimu- 
lating vital activity and heat production, may be employed. During 
the bath we can hasten the subsequent reaction by using mechanical 
or percussive measures, such as douches, friction over the wet 
sheet, etc. 

The manner of applying cold water to the surface influences very 
materially the question of reaction. A low temperature suddenly 
applied, with a higher surrounding temperature, accompanied by 
pressure or mechanical effects, produces prompt and active reaction. 
This can also be aided by voluntary movements, friction of the skin 
surface by the individual himself, and it may be stated that friction 
of any kind during the application of cold favors reactionary influences 
and prevents shock and collapse, a fact that will be carefully noted 
when we come to consider the application of the full bath in typhoid 
fever, the half-bath and dripping sheet. Baths that are cold or very 
cold, of very brief duration, with mechanical effects, hasten the result. 
Or the hot and cold measures may be alternated. After the bath 
reaction is favored by a warm room, hot enema, hot drink, friction 
with a crash towel or warm hand. Especial care should be paid 
to the legs and feet. A sheet should cover the patient as soon as 
reaction is secured to prevent evaporation of the moisture upon the 
skin surface that succeeds reaction. 

There are individuals — but very few, indeed — who do not react 
well, and who require careful application of hydriatic procedures, but 
a thorough knowledge of physiological conditions and technique will 
enable the hydriatist to educate his patients to react promptly and to 



52 PRACTICAL HYDROTHERAPY. 

the fullest degree. It is the author's invariable rule to require patients 
who are ambulatory to assist in rubbing themselves, not, as is generally 
supposed, to relieve the attendant, but to favor and stimulate reaction. 
Muscular movement, therefore, becomes one of the means of pro- 
ducing this condition. 

An atonic reaction follows after the prolonged immersion of the 
body in cold water, even where an endeavor has been made to suppress 
reaction by avoiding great cold or percussory measures, as in the cool 
and cold full bath. This, of course, is the object sought in those 
applications that are antipyretic, or baths used in typhoid fever, such 
as that of Brand. It should never be forgotten that it is the physician's 
duty to study his patient so that, especially at the start, he will not 
apply a stimulant that will exceed the powers of response. I take it 
that it is the essential keynote of every form of systemic hydrotherapy 
that perfect reaction is the object aimed at, and that unless this is 
secured the benefit is lost. The author does not believe in the admin- 
istration of narcotic poisons, such as alcohol, to prevent ( ?) shock. 
They are in themselves semi-antagonistic to reaction, and in febrile 
states add to the toxemia present. A failure to react is an exceedingly 
unpleasant condition, is usually accompanied by faintness, weakness, 
chilliness, cold extremities, pale cold skin, oppression, depression, 
lassitude, vertigo and headache. It is an evidence that the bath has 
been too much for the vital activities. Over-reaction or stimulation 
is attended by excitement, fullness of the head, headache and rapid 
heart action. Where reaction fails it is a sign to make the application 
shorter, colder, increase mechanical percussion and prepare the patient 
both before and after. Over-reaction requires cooling, non-mechan- 
ical measures at temperatures between 70° and 80° F. Kellogg 13 has 
tabulated these reactions as follows : 



Cold. 

ACTION'. REACTION. 

1. Contraction of the small blood- 1. Dilatation of the small blood- 
vessels of the skin, with dilatation of vessels of the surface, with contrac- 
internal vessels after a very brief tion of the internal vessels, 
contraction. 

2. Pallor of the skin. 2. Redness of the skin. 

3. Goose flesh appearance and rough- 3. Skin soft, smooth and supple, 
ness of the skin. 

4. Sensation of chilliness. 4. Sensation of warmth. 

5. Trembling, shivering, chattering 5. A sensation of comfort and well- 
of the teeth, in some cases decidedly being. 

painful and distressing sensations of 
"constriction," etc. 

6. First quickening, then slowing of 6. Slowing of the pulse, with in- 
thc pulse, with increase of tension. creased tension. 



13 Kellogg, J. H.: "Rational Hydrotherapy," 1906, p. 131. 



PHYSIOLOGICAL ACTION OF WATER. 53 

7. First checked, then quick, deep, 7. Respiration free, slower and 
gasping respiration. deeper. 

8. Cooling of the skin. 8. Heating of the skin. 

9. In most cases slight rise of in- 9. Fall of internal temperature, 
ternal temperature. 

10. Perspiration checked. 10. Increase of perspiration. 

Reaction is, then, dependent upon the vital capacity of the patient 
to respond, upon the general systemic condition, preparatory training, 
habit of using cold water, the temperature of the water, mechanical 
effects, duration of treatment, psycho-neural state, prior and past 
preparation. 

Contraindications. 

There are really few contraindications to the use of hydrotherapy. 
Certain conditions would lead to caution and care, but a physician in 
full possession of the physical and neural state of his patient should 
have no difficulty in adopting hydriatics to the case in hand He will 
always remember that it is not the disease he is treating, but the 
patient that demands his therapeutic ministration. The extremes of 
life — old age and infancy — require judgment in the case of hydriatics. 
We can, however, by carefully, cautiously and slowly training the 
reactive powers, develop their power to, respond to thermic stimuli of 
considerable strength, avoiding, therefore, very hot and very cold 
baths even after considerable training. Fatigue and exhaustion con- 
traindicate cold baths, but this can be overcome by a preliminary hot 
or very hot application, succeeded by a very brief percussory cold one. 
Profuse perspiration not due to heat, accompanied by fatigue, indicates 
warm applications and frequent drying of the surface without friction ; 
when stimulation has been brought about, very brief general measures 
may be used, or portions of the body rapidly sponged. 

Rheumatic and gouty people do not, as a rule, stand cold well at the 
start, but must be gradually trained. Cold bathing is a good prevent- 
ative of the "diathesis." A subnormal temperature and impending 
chill demand heating methods, and in these the incandescent electric 
light bath and superheated dry hot air are the best. Exotics, neurotics, 
neurasthenics, hysterics, undue mental excitability, etc., demand diplo- 
macy. Cardiac disease was for years considered a contraindication, 
but Schott has shown this to be a fallacy, and to-day we use the 
Nauheim bath to compensate organic heart lesions. Hot and very hot 
baths are contraindicated in these diseases, aneurisms, or in any ob- 
structive trouble with the circulation. The prolonged warm bath, with 
its devitalizing and atonic effects, should never be used save by medical 
prescription. Marked arterial disease and extreme debility contrain- 
dicate cold baths. In conclusion, we may say that good common sense 
and judgment, and the keeping within rational and temperate bounds, 
will prevent hydriatic mishaps. 



CHAPTER IV. 

THE INTERNAL USES OF WATER. 

Most of the medical fraternity appreciate, in a desultory manner, 
the value of drinking-water, and that it has therapeutic uses ; but few 
take occasion to acquaint themselves with the physiological action and 
administer it in a systematic, proper manner. From Hippocrates to 
to-day the drinking of water has possessed more or less mystical power, 
and the feeling that in "springs" or health spas there exists some 
subtle power has been shared by the medical profession. It has always 
suffered opprobrium through empirics, who, believing water a useful 
means to their ends, used the same to the discredit of the members 
of a learned profession. The physician, as a rule, has been very lax 
in his recommendations of waters supposed to possess certain marvel- 
ous curative powers because of the "naturally combined" salts they 
contain, the minute doses of which are supposed to effect the removal 
of poisons and the restoration to health. In truth, it was the water, 
plain H..O, and not the mineral. Gallons upon gallons of printer's ink 
have likewise aided its supposed "mineral" value. We can really 
understand its universal bodily need when we recall what Claude 
Bernard has said: "Life exists only in a liquid medium, it is only by 
certain artifices of construction that the organism of man, as those of 
other animals, can live without it ; but all the active cells upon which 
their functions depend live, without exceptions, like the infusoria, in 
a liquid medium." ' 

Water is one of the prime necessaries, its long-continued absence 
causing death. Man can live, as did Dr. Tanner, for forty days 
without food, but a very few days of absolute deprivation of water 
will cause death. When an animal loses 22 per cent, of its tissue water 
it dies, and a 10 per cent, loss will cause very grave disturbances. It 
ranks with air, heat and cold in its influence upon the processes of 
animal life. It may act as a food or nutrient agent, and as a solvent 
of all secretions; is a component part of every structure, excretion 
and secretion of the body ; is the great diluent by means of which the 
dissolved food material is conveyed to and waste material from the 
tissues to the excretory organs. Every cell and fiber of the body is 
kept moist and bathed by this liquid, and unless it is present the 
function of the tissue is destroyed. The blood stream is made fluid 
by its use; in its presence more oxygen is absorbed and more carbon 

1 "Etudes Physiologiques sur quelques Poisons Americains," Paris, 1864. 

(54) 



THE INTERNAL USES OF WATER. 55 

dioxide eliminated. It is the most grateful of all fluids for quenching 
thirst — a demand of the system to equalize the water which has been 
consumed in the processes of metabolism or eliminated from the body. 
It must be borne in mind that water does not act in a purely mechan- 
ical capacity, simply washing out toxins and waste material of tissue 
break-down, but is a true solvent, a powerful and vital stimulant ; an 
oxidizer that promotes tissue change, and in its turn stimulates recon- 
struction — in fact, acting as a general rejuvenating agent upon the 
system. 

Abstinence from water withdraws the water from the tissues, 
then increases the specific gravity of the plasma, reducing its solvent 
powers, and rendering nutrition and elimination impossible. The 
ingestion of large amounts of inorganic salts increases thirst by raising 
the specific gravity of the plasma, thus calling for more fluid to assist 
in their elimination. In the same way the eating of large quantities 
of proteid food, the end-products of which (urea, uric acid, creatin, 
etc.) thicken the plasma and demand dilution. Fats and carbohy- 
drates, the terminals of which are water and carbon dioxide, do not 
demand the same amount of water as proteid, for C0 2 does not 
increase the specific gravity of the plasma and is eliminated by the 
lungs. Restriction of water increases toxemia, does not decompose 
fats, destroys appetite and the total food ingested, which may thus 
cause reduction in weight. It is in this connection interesting to note 
that sugar and peptone, carbon dioxide and urea, a product of proteid 
oxidation, have a high degree of solubility in water. Uric acid, 
oxalic acid and other abnormal products are poorly soluble, hence, as 
has been shown by Haig, they readily accumulate in the body, es- 
pecially in those portions in which the circulation is least active. 

An agent capable of so much good makes it of importance that the 
source of water supply should be free from all the contaminating 
influences that arise from the ordinary pollution common in civilized 
countries. Rain washes out a great deal of mineral and organic 
matter from the air, which is carried into our lakes and streams, to 
which must be added the sewage from large and small towns. A 
heavy responsibility rests upon civic authorities to secure a water 
free from the mechanical impurities of dirt, mud and bacteria, 
as well as from organic matter, and palatable to the taste, an ideal 
water, difficult to secure under ordinary circumstances. 

Its physiological action is derived from the water itself, and not 
from any mineral contained therein. The effect of cold water taken 
internally is to refrigerate the part with which it comes in contact, the 
stomach, like the skin, having to overcome the impact of cold water 
upon its surface and bring about localized reaction. The mucous mem- 
brane of the stomach becomes pale, the blood-vessels and muscular 
structures contract. The cold water lying in the stomach causes a 



56 PRACTICAL HYDROTHERAPY. 

lowering of temperature, a fact utilized in fevers. When introduced 
into the stomach or rectum Winternitz observed that the temperature 
of both of these structures was lowered, that the temperature of the 
large intestine fell during a period of twenty-five minutes until a re- 
duction of 1.5° C. was reached. With the abstraction of heat the 
temperature of the water rises to the same as that of the surrounding 
viscus, at which time reaction sets in, the blood-vessels dilate and 
water is absorbed, slowly from the stomach, rapidly from the intes- 
tines. During this period glandular action is lessened. The muscular 
structures here as elsewhere are toned by the action of cold upon them, 
provided the quantity is not too great to stretch the viscus. The 
contents of the stomach and bowels are diluted by its local action. 
When reaction takes place the blood-stream is diluted and flushed by 
its presence. Reflexlv. the heart's action is slowed, the pulse fuller 
and less frequent, with raised arterial tension, easily shown by the 
sphygmanometer and felt by the finger. If a fairly large quantity — 
half to one quart — be ingested, there may be a fall of from ten to 
twenty beats, lasting for ten or fifteen minutes, according to my ob- 
servation. It has been pointed out by Winternitz 2 that the influence 
of the drinking of large quantities (quart) of cold water tends to 
produce a contraction of peripheral blood-vessels, and that its inges- 
tion reacts upon the temperature of the entire body. The effect upon 
the pulse and circulation is due to the direct stimulation of the fila- 
ments of the pneumogastric and sympathetic nerves and the accom- 
panying reflex action. 

The excretion of water falls more directly upon the heart than 
would at first be supposed; therefore the greater the amount intro- 
duced the greater the cardiac labor, just as would be the case with 
a force-pump. Weak hearts and weak kidneys are strained by too 
great volume of water, weakening the former, irritating the latter. 
In fact, abstention from water diminishes the total labor performed 
by the circulatory apparatus, and thus spares the heart. 

Their rapidity of action shows them to be of reflex origin. The 
rapid drinking of cold water increases temporarily respiration, but 
this quickly subsides. The free ingestion of water, like its applica- 
tion upon the external surface, favors the absorption of oxygen and 
the elimination of CO.. Upon the blood and lymph it acts as a dilu- 
ent where it is continuously drunk, although it may be so imbibed as 
to increase or dimish its fluidity. 

As a diluent it favors the suspension of the corpuscles and the 
solution of the albumins and globulins, effete material and inorganic 
salts that increase the solvent power of the plasma. 

Bocker has pointed out that immediately after the ingestion of 
considerable water, this increased amount is present in the blood, but 

2 Winternitz, \\m.. "Zierr.sEen's Cyclopedia of Therapeutics," Vol. IX, Hydrotherapy. 



THE INTERNAL USES OF WATER. 57 

shortly after this the blood becomes thicker and more condensed, 
showing that the water has entered the tissues. The absorption of 
water probably takes place through the veins of the stomach and in- 
testines, and the rate at which it is absorbed in health depends some- 
what upon its alkalinity and freedom from minerals, the presence of 
carbon dioxide gas being a stimulant to the vascular system to take up 
more rapidly the fluids contained in these viscera. It has been esti- 
mated that 10 per cent, of the water ingested is absorbed from the 
stomach and 90 per cent, from the intestines. 

It is a well-known fact among clinicians that the reasonable inges- 
tion of water favors digestive processes and assimilation. Not only 
does it favor absorption, but it becomes a medium by which the diges- 
tive pabulum is conveyed more rapidly to the tissues and nutritive 
exchange brought about. The writer has not only observed, but has 
had a number of people call his attention to the fact, that a patient 
eating the same amount of food with an increased supply of water in- 
ternally is apt to gain in body weight, which has led to the populariza- 
tion of the idea that water-drinking produces fat and tissue forma- 
tion, a fact that is borne out upon investigation. Glandular structures 
are stimulated, as is the digestive process, the intestinal juices and 
peristalsis. A larger and freer flow of bile occurs from the common 
duct, less tenacious in character and capable of more pronounced in- 
fluence in its digestive and antiseptic functions. The blood of the 
portal vein being diluted, this large glandular organ eliminates more 
toxins and waste products. Its action upon the muscular and secre- 
tory portions of the gastro-intestinal tract and liver is one of the ex- 
planations of why increased drinking of cold water overcomes habitual 
constipation. With the blood recharged with oxygen, more fluid in 
character, anabolic and katabolic processes are facilitated, and waste 
products of tissue change in the presence of this oxidizing agent dis- 
appear ; there is a general revivifying and rejuvenating influence, a 
baptism that literally makes the tissue born again. The human body 
becomes stagnated, its processes inactive, its secretion lessened, its 
excretion diminished, its nervous system more sensitive, when the 
body is not supplied with sufficient water, and reasonable ingestion is 
apt to insure increased activities in these directions. It is a well- 
known fact that where the body has been robbed of fluids, as in loss 
of blood, severe diarrhea, etc., there is increased thirst and desire for 
more water. It acts as a diuretic, increasing the watery and solid 
constituents of the urine, lessening nitrogenous tissue waste. Oxalic 
acid, sulphates, the so-called uro-toxic group and extractives are con- 
sumed. 

It has been found by Hawk 3 that copious water drinking increased 
the excretion of nitrogen and phosphorus by the urine, the former 

3 Uuiversity of Pennsylvania Medical Bulletin, 1905. 



58 PRACTICAL HYDROTHERAPY. 

due to washing out of the tissues of urea previously formed but which 
has not been removed by normal processes. Katabolic proteid pro- 
cesses being likewise stimulated, there is increased urea formed. .The 
greater phosphorus elimination resulted from the increased activity 
of the cellular structures of the body and the katabolism of nucleins, 
lecithins and other phosphorus-containing bodies. Maximum excre- 
tion occurred with absolute regularity on second day of water in- 
gested, while fluid excretion was greatest on days of copious drink- 
ing. In like manner Heihner, 4 experimenting upon dogs, came to 
the conclusion that the increased nitrogen was largely due to a more 
active katabolism in the body of organic material. 

Cold water should be only drunk in small quantities immediately 
before, during or for an hour after meals, for when taken cold into 
the stomach during the process of digestion it chills, diminishes the 
secretion of both hydrochloric acid and pepsin, as well as diluting the 
gastric juice. The ingestion of large quantities of water, especially 
at meals, is to increase the appetite. It may produce a lack of mo- 
tility and subsequent digestive disturbances. It should be especially 
avoided by those who have a dilated stomach. Like everything else, 
water must be administered with the object in view, and upon rational 
consideration of its physiological effect. If it is taken in too large 
quantities, and its use prolonged, it is apt to interfere with tissue 
change and promote disintegration. It is best administered at 50° to 
60° F., from one to two hours after to thirty minutes before meals, 
during which time the patient can drink from six to eight ounces 
every half to one hour. In this way the tissues become saturated, 
and physiological effects are obtained. 

Hot Water. 

The physiological action of hot water, taken internally, is similar 
to the action of this agent externally — that is to say. it tends to pro- 
duce an atonic condition of the structures with which it is brought 
in contact. The digestive system is relaxed, its juices diluted, the 
muscular and secretory functions weakened. The empty viscus is 
cleansed, and mucus and particles of food adherent to the stomach walls 
removed. The thermic impressions are conveyed to centers in the cord 
and medulla, increased heat absorption takes place ; the system, in its 
endeavor to equalize this, dilates the peripheral blood-vessels, per- 
spiration is induced and heat lost. It increases the heart action ten 
to fifteen beats per minute. After the water is absorbed its general 
action is similar to that of cold water, which has been described above. 

Hot water drinking is now a popular fad with the laity. There 
is no question but what, in some forms of gastritis, where there is a 



4 Heihner, E.: Zcitschrift f. exper. Path. u. Therapie, Vol. 47, p. 538, 1906. 



THE INTERNAL USES OF WATER. 59 

large accumulation of mucus in the stomach, the drinking of hot water, 
by removing this tenacious mass, favors the digestion of food. There 
are, however, many objections to its use even in these cases. 

Its physiological action is similar to the foundation of all hydro- 
therapeutic applications of water, viz., that hot water acts as an atonic 
agent, relaxing, depressing, debilitating; while cold water is tonic and 
stimulating to all structures with which it comes in contact. 

Therapeutics. 

The purest water is that which has been freed by distillation from 
all organic and mechanical impurities. This water, being deprived of 
air, has a disagreeable or "flat" taste, that can be obviated by the 
introduction of new air into the water. A simple way of doing so is 
to half fill a gallon bottle with distilled water, cork tightly, and place 
in a refrigerator until chilled, after which the bottle is to be agi- 
tated, whereupon the water absorbs the air and becomes palatable to 
the taste. By far the most pleasant beverage, both for general, hy- 
gienic and therapeutic use, however, is a distilled water at 70° to 
60° F. that has been carbonated — that is to say, charged with carbon 
dioxide. This water is pure and has a "snap' that makes it palatable. A 
secondary consideration is the fact that carbonated water is more read- 
ily and quickly absorbed from the mucous membrane of the stomach, 
and for this reason the author has never seen any harm result from 
the moderate drinking of soda-water, provided a pure fruit juice is 
used in connection with ice and carbonated water, although he is 
distinctly opposed to the use of this drink with ice cream. 

There is a charm about effervescence that is fascinating to most 
people. Natural effervescent or "sparkling" waters have always held 
a popular place, but have of late been displaced by the easier made 
artificial product. The carbonated and bubbling water possesses a 
mild stimulating property, singularly attractive to the average palate. 
In reasonable quantities the aerated water is without prejudice to 
health. Its physiological action is obtained from the water itself, and 
not from the mineral contained therein. Certain waters possess thera- 
peutic value because of their minerals, particularly the sulphates, but 
the good derived from ordinary mineral spring zvater can be obtained 
from the use of plain water, if drunk in sufficient quantities. There 
are many disadvantages in the ordinary mineral water, absorption 
being lessened and made more difficult the greater the amount of 
mineral matter it contains. It may be an Hibernianism to say that the 
best mineral water is the water that contains no mineral, but this, 
nevertheless, is a truism. Too often value is credited to mineral 
springs which in reality they do not deserve ; for it is from the rest, 
change of diet, freedom from care and worry, and the ingestion of 
large quantities of liquid containing a small or medium' amount of 



60 PRACTICAL HYDROTHERAPY 

mineral that results are obtained. It is likely that better results would 
have been obtained if they had used the water without any mineral, 
but simply carbonated. Frequently harm is done at springs by the 
endeavor to secure full monetary returns by drinking too freely of the 
water, and this also is the danger in its empiric use by the charlatan. 
The amount of water that the average healthy individual should drink 
ranges from six to eight glasses in twenty-four hours. In diseased 
states it is a question for the discrimination and discretion of the 
attending physician, who will prescribe it upon the full knowledge 
of its physiological action and the needs of his patient. In febrile 
states patients should be systematically given cold water, for it is an 
antithermic agent, stimulates all the excretory organs, especially the 
liver, destroys and eliminates toxins, leucomaines, ptomaines, etc. 
If free perspiration can be produced the temperature will be reduced. 

Debove, practicing Brand's method in typhoid fever, gives six 
ounces of cold water every two or three hours as a means of stimu- 
lating the excretion of the typhoid toxins. The urine frequently rises 
under water drinking to twice the normal, even in febrile states. 
Winternitz has suggested two simple processes by means of which to 
regulate the quantity of water the system should take to increase 
the fluid in the tissues, or to cause effusions to be absorbed. If it 
is desired to flood the tissues, small quantities should be taken at fre- 
quent intervals ; to stimulate absorption and remove serous exudates, 
administer a reasonable amount of fluid followed by a considerable 
period of abstinence, say once every twelve hours. He has secured 
excellent results in dropsy by so doing. 

As before stated, the free drinking of cold water stimulates the 
entire digestive tract, and removes one of the banes of modern civi- 
lized life, constipation, when this is due to simple causes. Two glasses 
may be taken before breakfast at 40° to 50° F. All persons afflicted 
with rheumatism, gout, uric acid and its allied toxins, should drink 
freely of water in such manner as to flood the tissues, favoring oxi- 
dative processes. The dry, inactive, scaly or greasy skin is much ben- 
efited by having its tissues freely drenched with water. This is facil- 
itated by external applications, followed by good reaction — in fact, 
all conditions pointing toward a free ingestion of water internally 
likewise point to its use externally. 

In diseases of the liver water should be drunk liberally, ten to 
twelve glasses daily, not only with a view of eliminating those crys- 
tallized substances likely to produce gall-stones, but to liquefy the blood 
in the portal vein, and thus favor the solution and elimination of intes- 
tinal as well as systemic poisons. By its introduction into the intes- 
tinal canal many of these poisons are oxidized and never reach the 
portal circulation. It is a fact, well known even to the laity, that the 
habitual drunkard, the periodic spreer, the morphine fiend— in fact, 



THE INTERNAL USES OF WATER. 61 

any one addicted to the use of a drug — can, to a certain extent, re- 
duce the amount taken and diminish its evil influence by free water 
drinking. Diuresis may be induced by large quantities of cold water, 
raising, as it does, the blood-pressure in the kidney. 

It should be borne in mind that cold water drinking is contra- 
indicated when one is very much fatigued, whether the skin be active 
or inactive, for shock and collapse may be thus produced. Hot water 
has very little use in internal therapeutics. By its mechanical help in 
removing mucus, it is useful in chronic gastric catarrh, being drunk 
one hour before meals at a temperature as hot as can be borne — so 
hot, in fact, that it should be sipped with a spoon. The object in drink- 
ing this an hour before meals is to permit of the stomach's returning 
to a normal condition before food is taken. It debilitates the entire 
digestive system. Its use is particularly pernicious in those cases 
who have an atonic or dilated stomach. Nearly all secretory dis- 
turbances are aggravated by its use except hyperpepsia, in which the 
amount of gastric juice is lessened. In some instances patients have 
received temporary benefit from the use of very hot water in neu- 
ralgic states of the stomach and bowel, possibly due to the removal 
of fermenting material and the relief of spasmodic conditions pres- 
ent. It relieves colic in a similar manner. We may provoke emesis or 
vomiting by means of the copious use of water ranging from 94° to 96° 
F. The author does not at all believe in the provoking of emesis, but 
much prefers the use of the stomach-tube, as by that means he is cer- 
tain of not only removing the stomach contents, but of knowing that 
the viscus is clean. Drinking water at meals must be avoided, save 
in small amounts. 



CHAPTER V. 

ASSOCIATED PROCEDURES. 

The hydrotherapeutist, in the practice of his science and art, calls 
into play certain procedures that are of themselves not truly hydrothera- 
peutic, but which have been for years indelibly associated with his 
work. For this reason we find them described in books upon this sub- 
ject; they form one of the essential means he has at command for 
obtaining results, and have by courtesy, so to speak, been relegated to 
this branch of medical practice. I have called them, because of their 
peculiar relation, "Associated Procedures," and will consider under 
this head, sunlight, incandescent electric light bath, arc light bath, 
hot air, superheated dry hot air, vapor of steam, etc. Some of these 
have been known for years, and were even utilized by the ancients 
for the preservation of health and the treatment of disease, while 
others are of modern growth, brought about by advances and im- 
provement in electrical apparatus. 

Sunlight. 

The finite human mind has difficulty in grasping the rate at which 
light travels, about 186,000 miles per second, but this dwindles into 
insignificance before an appreciation of the varying wave-lengths of 
the visible colors, which have been roughly estimated at one-half to 
two trillion. Light varies as to speed and wave-lengths, the division 
into heat, light and chemical rays being purely relative, one class 
merging into the other. Light waves are of shorter length than heat 
waves, but are capable of producing heat if they fall on a suitable ob- 
ject, and meet resistance. It is said that no substance permits all the 
rays to pass through it, and that no substance is capable of keeping 
them all out. The blue, violet and ultra-violet rays produce certain 
chemical changes of value, and are considered true actinic light. Bis 
calculated that with 100 as a standard the effects of light are, chemical 
96, other radiations 4, and says that at the present time it is impossible 
to state, exactly, the action of light. These chemical rays act on silver 
salts, are absorbed by glass, but pass readily through quartz, rock 
crystal and Iceland spar. Recent investigations seem to show that 
rays of every wave-length, from one end of the spectrum to the other, 
are capable of exerting some chemical actions. Light is a stimulant 
to both vegetable and animal life. The luminous rays are found mostly 
(62) 




Plate 16a — Indoor Sun Bath (Kellogg). 



ASSOCIATED PROCEDURES. 63 

in the central portion of the spectrum, while the heat rays lie in the 
lower end. The human body is translucent to these rays. If we hold 
the fingers over a powerful light, or introduce it into the cavities of 
the body, the intervening tissues glow and appear as a beautiful red 
body, this effect being known as translumination. 

Physiological Action of Light. 

Upon bacteria, sunlight and the radiations from the arc are de- 
structive, especially to lower forms, its action being more active in the 
presence of oxygen, and largely in proportion to the number of ultra- 
violet rays. Light is, in fact, a disinfectant, killing even tubercle 
bacilli in a few hours, especially if the sputum is dry. Light serves to 
maintain health by increasing sanitation. The fact that sunlight will 
kill many dangerous bacteria is made use of by engineers in purifying 
the water supply of large cities. It disinfects and destroys both patho- 
genic and putrefactive organisms, and prevents in the human bacterial 
and other diseases by increasing both red and white blood corpuscles. 
The whole human organism reacts and responds to the influence of light. 
Upon the skin strong sunlight acts as an irritant, producing the solar 
■ erythema, a dermatitis, ordinarily designated "sun burn," causing it 
to become red, to swell, sting and pain. Blisters may be formed, and, 
where the exposure is continued, necrosis may take place. Usually, 
however, the swelling goes down, the redness diminishes, the blisters 
dry up and desquamation occurs. Changes similar in character take 
place under the action of the arc light, several observers having re- 
corded the production of an erythema where an electric welding is 
done. Where the exposure is continued, deep pigmentation follows, 
serving as a barrier to further penetration and action in an inflam- 
matory manner. This is known as "tanning," and is believed to result 
from a destruction of red blood corpuscles, followed by a deposit of 
their pigment in the skin, nature thereby protecting the delicate struc- 
tures of the deeper layers of the corium. Sunlight quickly produces 
profuse perspiration, much more so than an equal temperature acting 
slowly by conduction. The cutaneous blood-vessels dilate, there is an 
increased quantity of blood brought to the surface, resulting in active 
stimulation of the sweat and sebaceous glands, followed by profuse 
perspiration. This is likewise true of those artificial measures simu- 
lating sunshine. The thermic impressions made upon the skin are con- 
veyed to the spinal cord, medulla and higher heat centers in these or- 
gans and the brain, accelerating the heart's action. With perspiration 
heat loss takes place. 

In a clear atmosphere the effect of sunlight is intensified. In Egypt 
the natives, especially the Arabs, protect their heads from the rays 
of the midday sun by means of large turbans, which form a huge mass, 



64 PRACTICAL HYDROTHERAPY. 

the heat of which would doubtless be intolerable were it not for the 
relief afforded by the exclusion of the exciting actinic ray. 

A common observation of the influence of sunlight upon the skin 
may be noted in the difference in appearance between those who are 
daily exposed to it and fresh air and those who are confined within 
doors, particularly in illy-ventilated, dark offices, working by gas and 
other artificial lights. In the former instance, as exhibited by the 
farmer and seamen, we find the ruddy and tanned skin ; in the latter, 
as exhibited by the bookkeeper, a pale and sallow one. 

Upon the nervous system, light energy has a stimulating and buoy- 
ing influence, speaking in general terms. The spirits of mankind be- 
come more cheerful and lively under the influence of sunlight, and 
cerebral activity is stimulated. The different colors of the spectrum 
are believed to produce certain effects upon the central nervous sys- 
tem, blue being described as cold, green as restful, yellow as cheerful, 
red as warm, while Goethe says, "Red and yellow are bracing, green 
and blue depressing."' Blue is believed to quiet cerebral action, and 
violet to cause sadness — it being one of the accepted emblems of grief. 
Juettner calls attention to the fact that red is a nerve stimulant par 
excellence, acting upon the sympathetic nervous system, and through 
this upon all vegetable and more especially the animal functions. It 
has ever been the color of passion and love, sexuality being affected 
by it, and it was supposedly for this reason that the lights, gowns 
and furnishings of the shrines of Venus were of this shade. What 
was true of the older nations is equally true of the modern ones, and 
the rules and promptings that guided them in the selection of this color 
are still in practical effect in modern life to-day. 

It is evident that there can be no persistent vitality nor healthfully 
developed bodily structure without light. If it were possible for a 
human being to be placed during the natural term of his existence in a 
position of perfect darkness, the physical tissues and mental faculties 
would undergo serious modifications and degeneration. Where light 
is not permitted to permeate, there are found bodily deformities, intel- 
lectual deterioration, crime, disease, early and often sudden death. A 
material as well as a moral and mental etiolation occurs when the 
vital stimulus of light is withdrawn. 

Compare the bright, happy faces and buoyant spirits of those who 
reside in the country, work in the open fields, and upon whom the sun 
is generally shining, with the pale, phlegmatic faces, emaciated forms 
and nervous depression of those whose vocation in life deprives them 
of the health-giving and beneficial influence of light. These patho- 
logical phenomena are observed among those confined in dark places, 
such as holds of ships, badly constructed houses, cellars, prisons, and 
wherever light has difficulty in penetrating. 

The same conditions are found in the dwellings of the poor in large 



T) 



I 

O 

•o 



O 




ASSOCIATED PROCEDURES. 65 

cities, where the light which finds its .way through the narrow and 
crowded streets is reflected. 

The exclusion from light is well known to produce organic altera- 
tions in the visual organs of animals, such as atrophy of the optic 
nerve or those portions of the brain more immediately associated with 
sight. It is supposed that the blindness observed among fish found in 
dark caves arises from the arrest in the development of the eyes, as a 
result of a constant deprivation of light. 

The corpuscular richness of the blood and the hemoglobin content 
are raised by the use of sunlight or the incandescent bath, a fact at 
once observed by those who will take the trouble to make the simple 
tests required. I have observed another fact from the use of light — 
mostly incandescent — that the red cells appear in a fresh specimen, 
prepared according to the method of Schleip, to be fuller and slightly 
larger than a specimen taken before the test. This does not apply to the 
healthy individual, in whose cells no apparent change takes place. 
The white cells are in greater numbers, and I am inclined to think 
their activity is increased. Assimilation and absorption are increased, 
as is shown by the gains in weight. This takes place provided the 
method used does not produce too severe or profuse loss by perspira- 
tion. Where it is judiciously combined with tonic (i.e., cold) hydro- 
therapy, and adapted to the individual requirement, there are few, in- 
deed, who do not add to the body weight. Both animals and man tend 
to develop and their bodily functions increase, Finsen remarking that 
the violet rays are veritable promoters of life and energy. Bis has 
noted the orientation of animals toward the light. Strasser observed 
that "an animal eliminated more C0 2 under the influence of light than 
when confined in the dark, and that a starving animal loses less weight 
at night than during the same number of hours during the daylight. 
Eggs develop more rapidly when exposed to the influence of sunlight 
than when kept in the dark. This is also true of the larvae of 
insects." 

Under the influence of natural light — sunlight — muscular struc- 
tures are greatly strenghtened, a fact that has been noted by Petten- 
kofer, Voigt and others. With the added absorption of oxygen, pro- 
teid in the tissues is consumed, both by actual oxidation and by raising 
the temperature of the blood. 

The best results are obtained when the body is nude. Civilization 
has ordained the encompassing of man's cutaneous surface in a vast 
paraphernalia of clothing, so that special preparation must be made 
so as to meet "nature's requirements," and yet conform to ethics and 
morality. This ideal state of affairs has been secured by Kellogg. 1 
His "open air gymnasiium" is : 



1 Kellogg, J. H.: "Rational Hydrotherapy," p. 960. 



66 PRACTICAL HYDROTHERAPY. 

"A high-walled enclosure provided with dressing-rooms and all 
necessary conveniences for out-of-door exercises at all seasons of the 
year, consisting of the following: A wide walking or running track 
extending around the outside of the enclosure, just one-tenth of a mile 
in length ; a swimming tank seventy-five feet long, thirty feet wide, 
eight feet in depth at one end and three feet at the other, with an ar- 
rangement for an abundant supply of water, so as to keep the con- 
tents of the tank always fresh and clear and at the proper tempera- 
ture (from 65° to 70°) ; a supply of wood, saws, axes, and plenty 
of material in the shape of logs of different sizes, from three inches 
to three feet in diameter; a large pile of white beach sand for those 
who wish to indulge in the sand bath ; swinging rings, horizontal lad- 
ders, a Maypole, appliances for lawn tennis, pitching quoits, and 
various gymnasium games. 

"On entering the outdoor gymnasium the patient removes all his 
ordinary clothing and dons a thin bathing suit or pair of trunks ; shoes, 
stockings and hats are discarded, for he desires to bring himself as 
nearly as possible into a state of simple savagery, and to throw off 
all the unwholesome restraints of conventionalism. A pair of sandals 
may be worn if desired, but it is better to expose the soles of the feet 
to contact with the earth and grass. He imagines himself a boy again, 
frolicking in the freedom of unrestrained activity ; he walks, runs, 
leaps, rolls about on the grass, buries himself in the sand, chops or 
saws wood, laughs, shouts, whistles, and fairly runs wild with exhilara- 
tion as he feels the impulses of new life and vigor thrilling through 
his nerves and bounding in his veins, and finally plunges into the pool 
for a swim, which cools and tones his skin. As he returns again to 
the prison-house of conventional clothing in which civilized human 
beings are compelled to live, he wishes heartily that civilization and 
nature had not drifted so far apart. 

"The out-door gymnasium is a marvelously potent means for de- 
veloping the restorative and healing powers of the body, and is the 
natural complement of the various thermic procedures of the hydri- 
atic method. No sanitarium can be considered as scientifically com- 
plete without a well-equipped out-door gymnasium. 

"More or less of the benefits of the out-door gymnasium may be 
obtained by out-of-door exercises, as boating, surf-bathing, swim- 
ming, etc. The out-door gymnasium has the advantage, however, 
that it may be employed at all seasons of the year, that the exercises 
may be accurately regulated and under the constant supervision of a 
competent director, and that the seclusion of the gymnasium affords 
opportunity for a more thorough exposure of the body to the influ- 
ence of light and air than ordinary out-of-door exercises. 

"For feebler patients, carriage riding provides a partial air bath, 
which may be advantageously utilized while strength for a more vig- 
orous exercise or more considerable degree of exposure is being ac- 
cumulated. Very feeble patients may be allowed to lie out on veran- 
das, or in sheltered places on cots or reclining chairs. This measure 
the writer has employed extensively for more than a score of years, 
and with most excellent results. The patient is as lightly covered as 
is consistent with comfort; the wraps should consist of white woolen 
blankets in cold weather, and white fabrics at all seasons, so that as 
much light as possible may penetrate to the skin. The writer's general 
instruction to his patients is to spend as much time as possible in the 




Plate 17 — Incandescent Electric Light Bath. 




Plate 18 — Incandescent Electric Light Bath, Horizontal. 



ASSOCIATED PROCEDURES. 67 

open air. Simply lying in the cool fresh air promotes appetite and 
normal metabolism, and greatly adds to the beneficial effects derived 
from other therapeutic measures." 

It is the author's belief that a combination of those measures which 
enable an exposure of the body to the action of sunlight, the air itself, 
and cold bathing, is the ideal one for the city dwellant who seeks a 
summer vacation or rest. This is especially true of the bookkeeper, 
clerk, or professional man who is confined for the major portion of the 
year within the walls of an artificially heated and lighted building. 
It is only in natural surroundings that a store of health and vitality 
can be laid up that will enable individuals to go for a long time along 
the road of life's struggles without the necessity of combating ill- 
health. Experience has taught me that it is wise and profitable to send 
those living at or near the sea-coast to the mountains, the inlander or 
mountaineer to the sea-shore. In addition all should be enjoined to 
drink freely of water while undergoing any form of sun or air treat- 
ment. 

Therapeutic Application. 

The therapeutic application of sunlight naturally resolves itself 
into two categories — to maintain and acquire health. The worn-out, 
fatigued denizen of the city may look for strength and recuperation 
from a life under the sun's rays; the anemic and chlorotic girl, the 
adult with malnutrition, chronic dyspeptics, the rheumatic, gouty and 
plethoric individual, the diabetic, the neurasthenic, will all find a 
sun bath of advantage in the treatment of their malady. The 
different organic processes of the body are stimulated, oxidation takes 
place more rapidly, health is maintained. Those individuals who have 
a dry, sallow, leathery sort of skin, who are suffering from the poison- 
ing of retained secretions, may expect from the utilization of the out- 
door gymnasium, country life with swimming, or a sojourn at the sea- 
shore, the maximum amount of good, for these measures will improve 
the quantity and quality of the blood, will eliminate and destroy con- 
tained toxins within the system, and promote nervous vitality. Care, 
of course, should be exercised in habituating one's self to the action 
of the sun's rays, and, by gradual pigmentation of the skin, secure 
protection from its dangers. Those who are so situated that they 
cannot leave business or professional life will be benefited by riding, 
driving, automobiling, boating, swimming, bicycling, golfing, or any 
other sport that carries them into the sunlight and fresh air. Where 
persons are sensitive to the action of light, it may become necessary to 
train the nervous system to stand exposure. It is best to wear at the 
start a thin straw hat, substituting for this a light cap, and later on 
going without any covering upon the head at all. Therapeutic ex- 
posure to sunlight should always be followed by the application of 



68 PRACTICAL HYDROTHERAPY 

some cooling procedure, any number of which will be described later 
on in this volume. 

In conclusion, it may be said that sunlight is a source of heat ; 
that in its action upon the body it is a powerful tonic ; that it increases 
the hemoglobin of the blood, stimulates and tones the nervous system, 
favors tissue change, and is destructive in its action upon bacteria. 

The Incandescent Electric Light Bath. 

The incandescent electric light bath, "artificial sunshine," the intro- 
duction of which into therapeutics we owe to Kellogg, is one of the 
most powerful and beneficial of those treatments placed in the hands 
of the skilled hydriatist. There is probably no more interesting con- 
sideration than the transmutation of energy found in the electric light 
bath. Let us go back ages upon ages, to the subcarboniferous period, 
when the vegetation was mammoth, and the "reeds and rushes grew 
tall and rank" under the sun's rays of that period ; when vegetation 
grew and developed to become the basis of the different coal measures 
of the present day. With the Titanic upheaval and compression, with 
the application of heat from unknown regions, this mass of vegeta- 
tion was compressed and prepared for the utilization of man after his 
advent upon this earth. Dug from the mines, the black diamond burns, 
causes its stored sunshine to convert the water into steam ; the steam, 
in its turn, moves the machinery by which the dynamo converts the 
energy of the coal into "artificial sunshine," and thus we may literally 
say that we are, when the incandescent light is turned on, basking in 
the sunlight of the carboniferous era; and this analogy is further 
carried out in its action and therapeutic application, for it is the near- 
est approach, in my opinion, to sunshine that we have yet discovered. 
This form of procedure acts upon the tissues in the same manner as 
sunlight itself. Instead of slowly entering the tissues by means of 
conduction, and imperfectly penetrating the skin, the human body 
permits the rays of electric light to pass readily through the dermis, 
and thus generate heat in the depths of the tissues, and this it does 
in a short time and without the depressant action of heat by conduc- 
tion. That it penetrates the tissues readily can be demonstrated by 
placing the hand over an ordinary incandescent bulb, when it will be 
noticed that the soft parts are illuminated. The electric light bath has 
so many advantages over all other methods of heating that the author 
feels too much attention cannot be paid to this agent in the treatment 
of disease. Incandescent electric light is generated by the dynamo, 
and, passing along a wire properly insulated, enters the bulb, where it 
meets with resistance. The bulb, a discovery of Edison's, is a vacuum 
provided with an entrance and exit wire. Within the vacuum a prop- 
erly constructed terminal offers resistance to the passage of the cur- 
rent, the resistance converting the current into light and heat. The 



H 



r 

j5' 






o 



o 
crq 




ASSOCIATED PROCEDURES. 69 

electric light bath does not depend for all iis action upon the heat gen- 
erated, but mostly upon the light itself, which is radiated from the dif- 
ferent bulbs, striking the cutaneous surface. There are two forms of 
electric light bath of which we shall speak, viz., the incandescent and 
the arc. 

Physiological Action of the Incandescent Electric Light Bath. 

This bath is most frequently used for the accumulation of heat 
upon the surface of the body, and to induce perspiration. It is much 
superior to any other method, is easily controlled, and the dosage 
satisfactorily regulated as to duration and intensity. It has an advan- 
tage over all other methods, in that the instant the switch controlling 
the circuit is closed every lamp is brought into play, at once throwing 
its whole force upon the body. It acts quickly as a heating procedure, 
bringing about an elevation of body temperature, followed by per- 
spiration. 

Action Upon the Skin. — Careful clinical studies made by the author 
during the past twelve years warrant him in the assertion that this 
electric light bath stands at the head of all methods as the most satis- 
factory, safe and efficient way by which perspiration can be induced. 
By means of its penetration, electric light stimulates directly the blood- 
vessels of the perspiratory glands and at the same time raises body- 
temperature by its action within the tissues. It is not altogether the 
action of heat itself upon the surface of the body, but radiant energy. 

Bouchard has stated that if we elevate the temperature of the 
blood seven-tenths of a degree Fahrenheit, there will be produced sen- 
sible perspiration. This is accomplished in a much shorter time than 
by any other means of heat application, for the light, penetrating the 
skin as light, and encountering the resistance of the tissues beneath, 
has its energy transformed into heat, and it is for this reason that we 
are able to produce effects with the electric light bath in one-third to 
one-half the time that is ordinarily necessary when we use other 
methods. Incidentally, there is an economic side in the saving of 
time, which is frequently valuable when giving this kind of treatment. 
Again, I wish to call attention to the fact that the radiant enrgy of 
the bath, when used as a heating procedure, is a powerful tonic and not 
a depressant. 

When the body is placed within the apparatus, the skin commences 
to redden, accompanied by a dilatation of the superficial trunk blood- 
vessels and small capillaries. Shortly after this, perspiration takes 
place. 

Action Upon Metabolism. — Radiant energy entering the body as. 
it does, acts as a powerful vitalizer and stimulant to cellular activity. 
That it produces changes in the system analogous to that of sunshine 
has long been recognized, and it is interesting at this point to note the 



70 PRACTICAL HYDROTHERAPY. 

observation of Siemens, who found that "when plants and vegetables 
were exposed to the electric light at nighttime, it was comparable to 
the sunlight in producing protoplasmic activity," and that "the electric 
light acts as a tonic to plants, so that they are able to endure adverse 
conditions which would otherwise cause them to collapse ; that the 
electric light is a true vital stimulus, since the effect of its use at night 
upon plants is essentially the same as that of the longer day of the 
arctics upon plants growing in that region." The electric light bath 
stimulates metabolism, as has been shown by Kellogg in his experi- 
ments, proving it to be a reconstructor of tissue and an eliminator of 
toxins. Elimination of carbon dioxide was markedly increased, al- 
though the temperature of the bath was kept constantly below that 
of the body, viz., 97° F. The urinary secretion showed a diminished 
amount of urea and total solids during the twenty-four hours, which 
was evidently the result of increased elimination by the skin, thus 
stamping this bath as a powerful vicariant, a fact that is borne out by 
daily clinical experience in the treatment of rheumatism, Bright's 
and diseases of metabolism. The writer's observations and experi- 
ments have shown him that where the electric light bath is used in 
connection with other hydriatic procedures, there is a marked increase 
in the excretion of urea and solids in the urine and diminution of 
uric acid and the uro-toxic group. That nutrition is stimulated by 
this bath I have experimentally determined by a study of the gains in 
weight. In some cases this is marked, and occurs in spite of the 
fact that the patient remains upon a toxic diet — that is to say, a diet in 
which meat forms a fair proportion of the ingesta. The above changes 
•.are enhanced by the action of the rays upon the blood itself. 
The electric light bath produces an increase in hemoglobin as well 
as red corpuscular richness. 

Upon the nervous system the electric light bath is a tonic, stimu- 
lant and vitalizing process, from which we may expect excellent re- 
sults in all nervous affections, especially when accompanied by tox- 
emia. These individuals are prone to feel the devitalizing effects 
of heat, more or less depressing in character, and for this reason the 
electric light bath, with its tonic influence, is especially adapted as 
a heating procedure. I have observed that nervous patients more 
quickly and satisfactorily react to cold water treatment when the 
application is preceded by the use of this bath. 

The action of the local electric light bath upon the tissues sub- 
jected to its influence, viz., joints, inter-joint structures, abdomen, 
chest, spine, etc., is the general therapeutic influence of the incan- 
descent bath above enumerated, except that its action is localized 
within the tissues subjected to its rays. Even where this is limited 
to a small area, such as a joint, there is, of necessity, a general in- 
fluence to be derived from its application, and which may be summed 




Plate 20 — Incandescent Electric Light Bath, Closed (Mott). 




Plate 21 — Incandescent Electric Light Bath, Open (Mott). 





1 iAH 1 


1 r itt> 1 

1 4 Jg? ■ 


■ ^ I 
1 f- # 1 


1 *& nA 1 
HI ' r'SJ 




■4 •"»' " ► 



Plate 22 — Local Incandescent Electric Light Baths (Kellogg). 



ASSOCIATED PROCEDURES. 71 

up in the statement that its primary and local application produces 
in the locality to which it is applied the same action as a general 
application, with mild secondary systemic effects. 

The Arc Light Bath. 

In the arc light bath we have to deal with an active energy that 
is considerable. The heat from the arc is intense, the active horse- 
power energy of which is said to be greater than that of the effective 
rays of the sun at the earth's surface — that is to say, the surface of 
the sun radiates 10,000 horse power per square foot of its surface, 
but the earth receives only one-third horse power per square foot, 
of which about one-third is absorbed into the atmosphere. An arc 
having a crater of one-twelfth of an inch is estimated to radiate 
about 12,000 horse power energy, which is in excess of the sun's 
power. The brightest part of an arc is a small area within the crater 
of the positive carbon, the temperature of which is approximately 
from 6,200° to 6,300° F. It is from that spot that the greater part 
of the energy is derived, and which compares with the sun in bright- 
ness. In the arc light we have to deal more particularly with the 
actinic or chemical rays of light, and it is from their influence that 
we may expect benefit to the diseased human body. While the arc 
light emits powerful and stimulating rays, still it does not compare 
for general use with the incandescent bath. 

In its physiological action upon the surface of the body the skin 
is stimulated — even irritated — by its rays, resulting in a dilatation of 
the capillaries and larger blood-vessels, accompanied by a rise in 
temperature and active fluxion of blood to the surface. Perspiration 
is induced, and, where the heat of the arc light is retained, we have 
superadded all the influences that arise from heat of any kind, with 
the added advantage of its vitalizing action. I consider the arc light 
better suited for localised treatments, especially superficial in char- 
acter 

Actinic rays emanataing from the arc light are germicidal in their 
action, and are destructive to bacteria upon the surface of the skin, 
as in lupus, though they do not penetrate beneath the surface. The 
aim in the arc light bath is not so much the production of heat effects 
as the more purely actinic surface action. The arc light bath is, as 
a rule, little used by hydriatists, but belongs more particularly to 
another field or specialty. 

Technique. — Many electric light baths are now constructed and 
upon the market, and from which the intending purchaser can select, 
but certain rules should be borne in mind. It is essential that the 
wood entering into its composition should be preferably of oak, 
well seasoned, and, in addition, kiln dried. The wires entering the 
cabinet and connected with the different incandescent lights murst 



72 PRACTICAL HYDROTHERAPY. 

be large, well insulated, and where a connection is made the connection 
should be soldered and the joint well taped. I personally prefer the 
Edison or screw base for the globe itself, as I believe in this way the 
light is more secure and a better contact made. In cities the alter- 
nating current is generally used, with a voltage from 52 to 110, the 
latter, for a number of reasons, being preferable, as it gives a steadier 
light, somewhat more intense in its action. 

In 1895 the author constructed his first electric light bath, and 
has deviated little from the model he then adopted. 1 have always 
believed in a superabundance of lights ; in fact, twice as many as are 
really necessary, so that almost any degree of heat or light effects 
may be obtained. The cabinet I now use can be constructed by any 
really good mechanic. It is 4x4 feet, with a floor on the inside at 
such a height as to make it comfortable for one to sit upon a re- 
volving stool with the head outside. A door of sufficient size opens 
to admit the entrance of the patient. The interior is lined with asbes- 
tos and is supplied with 138 16-candle power lights arranged in 
vertical rows equidistant from one another, with the exception that 
there are two double rows placed opposite the spine of the patient. 
The lights are mounted upon porcelain bases, and between them are 
placed French plate glass mirrors so that there may be multiplication 
by reflection. The wiring is carried through the cabinet in porcelain 
conduits to a switch-board, of which I shall speak later. A false 
outer shell covers the wires and conduits, so as to give the cabinet 
a pleasing appearance. The switch-board has snap or double knife- 
blade switches, one for every row of lights. The advantage of this 
is at once apparent, as the physician is enabled to regulate the number 
of lights and grade the intensity of the application. It is advantageous 
to have a very large double knife-blade switch on the main wires 
of the current, but the novice should remember never to throw in 
this large switch when the smaller switches are all turned on, as he 
may "blow out" the fuse now required upon all such currents. 

In practice the patient enters the bath and takes his seat upon 
the revolving piano stool, which can be raised or lowered to suit 
the body length. His spine is uniformly exposed to that portion of 
the cabinet containing the double row of lights. The board is 
dropped into place around the neck and the door closed ; a large 
towel is then put loosely around the neck to prevent the escape of 
heat. This is a small matter, but it is an exceedingly disagreeable 
one to a patient to have the hot air of the cabinet stream in front 
of his face, and I have known cases to be made faint by just such a 
neglect of detail. In the case of men a cold cloth or ice-cap is placed 
upon the head ; women may wear an oil-silk or rubber cap, over 
which is placed the ice-cap or cold cloth, or, what is better, have 
a cold towel wrapped around the upper neck or throat. Recently I 





Platf. 23 — Light and Arc Cabinet Combined, Open (Monell). 



C\ 




Plate 24 — Light and Arc Cabinet Combined, Closed (Monell). 



ASSOCIATED PROCEDURES. 73 

have used with much satisfaction a rubber helmet which has a suffi- 
ciently large mouth to permit small pieces of ice to be introduced. 
This helmet keeps the head cool, does not wet the hair, and is espe- 
cially appreciated by ladies. As a result I have entirely dispensed 
with the turban, pad or cold collar in my practice. 

This is done for the purpose of preventing the fluxion of blood to 
the head, which would be followed by faintness, vertigo, palpitation, 
etc. The duration of the bath will depend upon the individual case, 
but ranges somewhere between three and twenty minutes. It is a 
common fact that cases at the start require very much longer ex- 
posure to the action of the bath, and that as improvement takes place 
there is a more rapid and prompt response of the body to the influence 
of the light, and therefore the duration becomes lessened. The 
incandescent bath may be used in two ways. Where the patient is 
only permitted to remain in the cabinet until the skin is flooded with 
blood, but perspiration lias not taken place, a powerful tonic and stim- 
ulating procedure takes place without many of the eliminative and 
other actions heretofore described. Where the patient remains until 
free perspiration takes place the physiological action above described 
is the result. 

In the author's hands the incandescent electric light bath is merely 
an associative procedure, a measure by means of which he stimulates, 
vitalizes and prepares his patient for hydriatic methods, of which the 
reader will find any number described in later chapters of this work. 

Therapeutic Application. — As indicated above, the author has 
found the incandescent electric light bath to be the most successful of 
all known methods as a preliminary to further hydriatic measures 
and for the application of heat to the general body surface. In 
localized procedures I have had better success with superheated dry 
hot air. The adaptability of the light bath to every case is easily 
accomplished by means of the switch-board ; by changing the number 
of lamps the intensity of the bath is regulated. This bath is instantly, 
absolutely and positively under the control of the operator. In an 
electric light bath of short duration, followed by any of the cold per- 
cutient measures hereafter described, we have a combination of 
effects far reaching in their action and of marvelous reconstructive 
capacity. Where the bath is continued until free perspiration takes 
place the patient should remain from five to fifteen minutes, but in 
any event must be followed by some cooling application. I have 
found the combination of the electric light bath with hydriatics one 
of the most powerful known measures for overcoming anemia and 
chlorotic conditions, especially in young women. As an enhancer 
of appetite, increasing digestive capacity and overcoming intestinal 
torpor, it is the remedy par excellence. Those suffering from gout, 
lithemia, rheumatism (acute and chronic), the uric acid diathesis, 



74 PRACTICAL HYDROTHERAPY. 

myositis and myalgia dependent upon these conditions, will find relief 
in the painstaking and persistent application of these measures. In 
neurasthenia, hysteria, insomnia, neuralgia, neuritis, migraine, chorea, 
and all functional nervous troubles, it is invaluable. I consider the 
electric light bath and hydriatic procedures for chronic malaria and 
syphilis, as a supplement to the use of quinine, mercury and the 
iodides, unequaled by any other known therapeutic resource. The 
local electric light bath is useful in the treatment of painful condi- 
tions and local disorders. It is of special use in spinal neuralgias, 
spinal irritation, lumbago, localized pains of all kinds, etc., but after 
its application either localized or general applications of cold should 
be made. 

For the application of the arc light in therapeutics the reader is 
referred to the cut of the combined incandescent and arc bath, either 
of which can be used singly. As heretofore indicated, the arc light 
bath finds its greatest usefulness in skin affections, neurasthenia and 
general debility and in painful nervous states. 

Hot Air Cabinet; Turkish Bath; Vapor Cabinet; Russian Bath; 
and Superheated Dry Hot Air. 

I have grouped these procedures under one general heading, as 
the physiological action of each is practically the same, the minor 
differences being of such a nature as not to invalidate the added value 
of considering them collectively. They differ essentially and rad- 
ically from the action of sunlight and radiant energy, in that the 
applications produce their results by directly communicating heat to 
the surface and from there entering the tissues by conduction. 

A human being can tolerate a water bath at a temperature of 
113° F. (45° C.) for eight minutes' duration with danger to life, 
while a general hot-air bath at a temperature of 260° F. (127° C.) 
for eight minutes is well borne, and temperatures far exceeding this — 
350° and 400° F. — can be applied to the general surface or localized, 
provided certain precautions are taken. Of all these baths the 
Turkish is the oldest. The physiological action of the Turkish bath 
and the hot-air cabinet is practically the same, with the added advan- 
tage in favor of the cabinet, though, as I will show later on, the 
cabinet in the home is very much abused. The user of the cabinet 
inhales fresh air and the pulmonary mucous membrane is not sub- 
jected to the direct action of the hot air itself. Perspiration is more 
rapid in the hot-air bath and jn the superheated dry hot air and least 
so in the presence of steam; in fact, the presence of water of any kind 
interferes with the secretion of perspiration. The North American 
Indians used to improvise a Russian bath by pouring water upon 
heated stones, and in Finland the same process is followed to-day. 



! 



►ti 



X 
o 



td 
o 
a. 

> 
•o 
•o 






H 
p 
a" 



o 




ASSOCIATED PROCEDURES. 75 

The Eskimo uses hot air, building a fire in his hut, raising the air of 
the chamber to such a temperature as to produce free and active per- 
spiration. The Finns and Eskimos suddenly leave their apartments 
and plunge into the snow, a somewhat rigorous procedure. All these 
baths must be followed by some temperature-reducing method, any 
number of which will be found in a subsequent chapter. 

Physiological Action of Heat by Conduction. 

The primary physiological influence of hot air or steam upon the 
body is the result of thermic irritation conducted to the structures and 
tissues beneath the integument. When a person enters the hot-air 
room or steps into the cabinet, after a short or longer period of time, 
usually from three to ten minutes, the surface of the body begins to 
become warm. Gradually the layers of the skin absorb the heat until 
it reaches the lower structures and acts upon the blood-vessels them- 
selves. The skin then fills with blood, the perspiratory glands begin 
to discharge their secretion upon the surface, at the start in the nature 
of a dampness, later along in beads, as the fluids of the body are more 
freely directed toward the surface. Thirst is now, as a rule, ex- 
perienced, and the patient should be made to drink freely of plain or 
carbonated water. Heat thus applied is for a short time a vital 
stimulant, acting upon all the structures, tissues and glands with 
which it is brought in contact, but only of a temporary nature, and 
is followed by its natural or secondary effect, viz., depression. This 
depressant or atonic effect is disagreeable, and must be carefully 
guarded against. In the Turkish bath the inhalation of the dry hot 
air not only excites the skin, but stimulates the enormous area of the 
pulmonary circulation, and to a certain extent favors the elimination 
of toxins by this membrane. Its action upon the skin remains for 
some hours after the bath. 

The value of sweating as an eliminative measure is perhaps not 
so great as it has been popularly believed to be, the percentage of 
urea and other toxins contained in the sweat, especially when profuse 
perspiration is induced, is small — indeed, very small — when com- 
pared with the percentage of these tissue poisons as ordinarily found 
in the urine. However, under some circumstances, they are carried 
off through the skin, as is evidenced by the peculiar urinous odor 
noticeable when profuse perspiration is induced in a patient suffering 
from renal insufficiency. 

The sweating-bath (followed by a cold application), though by 
no means a perfect substitute, does, nevertheless, to a very consider- 
able degree relieve the system of the excrementitious wastes which 
accumulate within the body when a sufficient amount of exercise is 
not habitually taken. This is accomplished by increasing oxidation 
and renewing the body by stimulating tissue changes. Sweating 



76 PRACTICAL HYDROTHERAPY. 

softens the sebaceous matter which often accumulates in the ducts of 
the skin and loosens the dry epithelium that obstructs the outlets of 
the perspiratory ducts. 

It is practically impossible to effect a permanent cure in a large 
number of chronic disorders without first restoring the skin to a 
normal state. Diseased conditions are common among civilized races 
because of the influence of clothing and the neglect of a daily bath. 
Sweating-baths are of the highest value as a means of ridding the 
skin of its accumulated impurities, opening up the obstructed lymph- 
channels and spaces, encouraging the circulation of nutritive fluids, 
stimulating gland structures, unloading obstructed sebaceous follicles 
of their hardened contents, arousing to activity the nerve ganglia and 
secreting cells of internal organs through reflex movements set up 
by the cutaneous sensory impressions made, and relieving by skin 
activity visceral congestion and other functional disturbances. 

Respiration is increased in frequency in from three to five min- 
utes, and becomes more superficial and supracostal in character. For 
a while there is more or less oppression until relief is afforded by the 
breaking out of perspiration and the elimination of moisture from the 
2,000 square feet of pulmonary mucous membrane. With the watery 
vapor escape CO, and toxic substances, volatile in their nature, to 
which Charrin has called our attention. The probable explanation of 
the physiological increase of respiration during the application of 
these measures to the surface is to be found in a combination of 
factors — irritation of the peripheral nerve terminations, superheated 
blood carried to the vagus respiratory center in the medulla, an 
increase of carbon dioxide demanding respiratory action to permit of 
oxygen absorption. 

Heat profoundly affects the circulation. After the patient enters 
the bath the pulse-rate begins to increase, and in from five to ten 
minutes it may rise from twenty to fifty beats. A continuance of the 
application causes an active congestion of the skin, which, with the 
induction of perspiration, becomes soft and lax. The arterial trunk 
and capillaries become distended with blood, especially the latter, 
for, possessing only a thin cellular membrane, they are capable of 
enormous dilatation and expansion, frequently several times their 
normal size. With the increased activity of the circulation in the 
skin, with the acceleration of the pulse, blood pressure is lowered, a 
fact discernible by the finger and sphygmomanometer. Owing to 
the lessened resistance of the peripheral arterial system, the blood 
stream is propelled with less labor to the surface and anemia of the 
internal viscera takes place, especially of the brain. A sensation of 
faintness, vertigo and tinnitus is far more common in Turkish and 
Russian than in the cabinet bath, because in the latter the head is 
kept cool and fresh air respired. With free perspiration the pulse- 



►d 



On 
I 

in 

c 



o 



td 
o 

D. 

> 
■o 
■o 



?3 



TJ 
» 




ASSOCIATED PROCEDURES. 77 

rate diminishes some, relaxation takes place and the oppression and 
discomfort disappear. 

The first effect of these applications upon the nervous system 
is that of a stimulant, exciting the nerve centers through reflex 
action arising from impressions made by the thermic irritation 
upon the skin. This is of short duration and is followed by a pecu- 
liarly agreeable sensation of ease and languor. Continued for a 
longer period of time, exhaustive symptoms begin to appear, notably 
lassitude, mental as well as muscular, the ultimate end of which is 
intense depression. 

The multitude of thermic impressions that arise from heating pro- 
cedures act reflexly upon the central nervous system, assisted by the 
direct action of the heated blood upon the nerve centers themselves. 

The anemia resulting from the increased circulation in the skin 
is an added feature. Its action upon voluntary and involuntary 
muscular fiber is the same. A short general application of heat is 
stimulant in practically the same manner as a short application of 
cold, while its prolonged use has the reverse effect, lowering tone, 
energy and relaxing the fibers. This fact is utilized clinically by the 
medical fraternity, and laity as well, in the treatment of muscular 
cramps, especially those of the intestines, and by the surgeon in over- 
coming strangulated hernia and retention of urine. 

The lassitude that accompanies a general application of heat is to 
be explained by its depressing nerve effects and to the relaxation of 
muscular tissue itself. 

Upon the blood heat diminishes the number of red cells and in- 
creases the leucocytes, and this is true whether the application be 
general or local, though local leucocytosis is much more marked after 
localized procedures than general applications. The alkalinity of the 
blood is lessened, diminishing its vital resistance and increasing its 
toxicity, with the production of active perspiration, and, provided water 
is not drunk, the general volume of the blood is lessened, due to 
actual water less. 

The influence of heat upon the digestive apparatus is a secondary 
one, for where it is not followed by the proper after-treatment there 
is a relaxation of the musculature of the entire tract, with a retention 
of gases, indigestion and fermentation, the latter giving rise to putre- 
factive processes, from which auto-intoxication takes place. The liver 
is little affected, although there is a tendency to diminish and thicken 
the biliary secretion. 

The action of heat upon metabolism is a frequent clinical observa- 
tion. An elevation of temperature and increased circulatory activity 
favor oxidative processes and carbon dioxide formation. By the 
action of prolonged heat some fat combustion takes place, and in the 
reduction of obese persons this measure, together with the restriction 



78 PRACTICAL HYDROTHERAPY. 

of fluids, is frequently employed. The various end-products circulating 
in the blood are oxidized and put in more favorable condition for the 
action of the eliminative organs. 

Experiments show that the elevation of temperature induced by 
general hot applications aids the body in the formation of alexins and 
antitoxins. Animals suffering from infectious diseases live longer 
when subjected to the influence of moderate heat. The recognition 
of this fact has led to the revival of the dictum of Hippocrates, that 
the elevation of temperature that occurs in connection with most acute 
infectious diseases is, within limits, remedial in purpose and effect. 
By parallel reasoning we are led to the conclusion that a slight degree 
of pyrexia artificially induced by a general hot application may be 
benficial in aiding resistance to infection, especially when followed by 
a short cold bath. 

Elimination is enhanced. By oxidative processes toxic groups are 
converted into urea, and this end-product is eliminated in larger quan- 
tities for some days, even after the application of one bath. Uric acid 
itself is eliminated, due to an absorption into the circulating medium of 
that which is stored in the tissues, its greatest elimination being shortly 
after the bath ; the chlorides, sulphuric and phosphoric acids and ex- 
tractives are favorably influenced. The quantity of urinary water 
lessens somewhat in proportion to the quantity of perspiration induced. 

Local superheated dry hot air produces primarily an agreeable 
sensation of warmth and relaxation. This is followed, in a short time, 
by a marked increase in the quantity of blood circulating in the vascular 
stems and capillaries of the part subjected to the heat. Relaxation, 
copious perspiration and elevation of the temperature of the blood take 
place. Moderate general perspiration ensues. The active perspiration 
of the part eliminates a great many toxic materials, both organic and 
inorganic, and this is of value in the treatment of localized infections. 
Upon the nervous system it acts reflexly, checking pain in a marvelous 
way. In the writer's somewhat extended experience of eighteen years 
nothing has proved more gratifying to him than the influence of super- 
heated dry hot air locally for the relief of pain and paresthetic sensations 
which so frequently accompany painful states. Reflexly, the pulse-rate 
and respiration are slightly accelerated by localized applications of dry 
hot air. These applications produce profound trophic influences upon 
the part, especially observable in the improved nutrition that takes 
place in gouty extremities and around the joints of arthritis deformans. 
That it enhances function, increases tissue resistance and stimulates 
reconstruction is a constant observation. Upon the lymphatic system 
dry hot air increases the flow along its channels, whipping up glandular 
action, and thereby aiding in the removal of waste products. The 
elevation of temperature to which the part is subjected favors oxida- 
tion and the destruction of effete materials. It may be stated that, 



13 



c 
O 



o 



td 
o 
a. 



o 



C/J 



n 







I 

m 

c 
•o 



o. 

a 



o 



o 

> 



TJ 



oq 
H 




ASSOCIATED PROCEDURES. 79 

barring the intense local effects, the general influence is that heretofore 
enumerated in the preceding pages of this chapter. I have, so far, 
failed to notice in the literature of this subject the application of local- 
ized cooling methods after the use of this agent. In the limb, or part 
subjected to the heat, are greatly relaxed blood-vessels and tissues, and 
it is necessary, in order to produce reaction and maintain the blood in 
the part, that the treatment should be followed by a brief application 
of some tonic and temperature-abstracting procedure ; otherwise the 
part will become gradually chilled by evaporation of perspiration and 
the condition may be aggravated rather than helped. The writer has 
found it of considerable value to not only use a localized application 
of cold, but a general systemic one. 

Apparatus and Technique. 

The apparatus and the methods here described of necessity limit 
their use to sanatoria, institutions and hospitals provided with a 
thorough and complete outfit, which, the writer is sorry to confess, 
is a rarity when we consider the number of private, public, special 
and general hospitals and sanatoria. In considering technique it must 
be borne in mind that the greatest care should be exercised to avoid 
burning the patient. Persons who have carelessly used these treat- 
ments have sometimes sacrificed lives by improper methods of appli- 
cation. The use of "home" methods by the patient alone necessitates 
a labor that should be performed by another, to say nothing of the risk 
of conflagration and personal burning. Private homes have no facil- 
ities for after-treatment, nor is the temperature of the room, as a rule, 
kept sufficiently high to prevent evil consequences following its use. 
It is the writer's firm belief that apparatus using gasoline, kerosene, 
alcohol and others of this group should be used in private homes with 
great care, and never countenanced in public sanatoria. 

Hot-Air Cabinet. — The apparatus is constructed of wood, prefer- 
ably of three layers. The inner perpendicular layer of lumber is best 
made of tongue and grooved poplar, upon which is tacked asbestos; 
over this a thin sheet of poplar is nailed horizontally, another layer of 
tar or heavy building paper added and a second perpendicular row of 
tongue and grooved poplar screwed upon the outside. The floor, 
four sides and the stationary part of the top are to be so constructed, 
the whole to be painted inside and out with fireproof white paint. 
Upon one side a narrow perpendicular door (or two) swings upon 
hinges just wide enough for a person to comfortably enter the cabinet 
and sit upon a stool, which should have a revolving seat so that it can 
be raised and lowered to accommodate the patient. In the top a 
circular hole is cut of proper dimensions to permit of the head re- 
maining outside the cabinet and a loose removable board to allow of 
the patient taking his seat, after which it can be adjusted comfortably 



80 PRACTICAL HYDROTHERAPY. 

around the neck. My own predilection is for the use of the steam- 
pipe radiator, and I thoroughly agree with Baruch that this is by far 
the best and simplest method for applying heat in the hot-air cabinet. 
Of course, heat may be forced into the cabinet, but from a practical 
standpoint the former is much preferred. A large excess of radiating 
steam coil surface should be placed in the cabinet, as it is a very easy 
matter to reduce temperature when it is desired. As a matter of 
economy, if it is so desired and the bath has been properly constructed 
as above outlined, it can be used for a Russian vapor cabinet as well, 
all that is necessary being to have an open pipe or several openings by 
means of which the steam may enter the cabinet. I have never favored 
the use of steam, nor do I consider the Russian bath a valuable one, but 
from experience restrict my work to hot air and radiant energy. 

The patient, nude, enters the cabinet and seats himself comfortably 
upon the stool so that his chin is just above the outside level of the 
cabinet. The attendant adjusts the loose boards snugly, and also wraps 
a large Turkish towel around the neck to prevent escape of heat, 
which would reduce the temperature of the bath and also be exceed- 
ingly unpleasant to the patient. The door is closed, the steam turned 
into the radiating coil and the cabinet gradually heated to such a point 
as is desired. The temperature may be controlled by means of a valve 
which permits of a larger or smaller quantity of steam entering the 
coil. The patient's head should be enveloped in a wet cloth, turban 
or ice helmet. The usual temperature of such a bath ranges from 
150° to 200° F. and its duration depends entirely upon the case in 
hand. Where stimulation is desired it should be continued until per- 
spiration is barely detectable; if, on the contrary, the full effects here- 
tofore described are to be obtained, it should be continued until free 
perspiration takes place. The main difference and distinction between 
the action of this and the Turkish bath is that the patient inhales cool 
fresh air while the surface of his body is exposed to the heat. Owing 
to the fact that hot air is not inhaled, the cabinet is somewhat slower 
in its action than that of the Turkish bath, and much safer. 

Turkish Bath. — In the Turkish bath the bather enters the dressing 
room, removes the clothes, and, throwing a sheet around him, prepares 
to enter the hot-air room. He should first wet the face and hair of the 
head thoroughly and drink at least one or two glasses of cold water. 
He then enters the hot-air room and lies down upon a couch. For a 
few moments there is a sensation of oppression, but usually by the end 
of from five to fifteen minutes he begins to perspire and relief is ex- 
perienced. The air of this room is most frequently heated by steam 
coils, and in this respect is most unhygienic and disagreeable, as the 
different persons entering the room are more or less compelled to 
inhale the contaminating air of the chamber. The best method of 
heating is with currents of hot air, by means of which ventilation is 




Plate 29 — Superheated Dry Hot Air ; Local Application ; Foot Bandaged in 
Turkish Toweling Ready to be Introduced. 




' 



Plate 30 — Superheated Dry Hot Air ; Treating Foot. 




Plate 31 — Superheated Dry Hot Air; Treating Hand and Arm. 




Plate 32 — Superheated Dry Hot Air: Treating Knee with Special Apparatus 

for this Joint. 



ASSOCIATED PROCEDURES. 81 

secured and fresh hot air introduced, it being the idea of modern 
furnace heating. The hot air should enter at a point several feet below 
the ceiling, and the foul air vents that carry away the impurities be 
located near the floor. Users of the Turkish bath, should they fail to 
perspire, must at once leave the hot-air room, as injury may be sus- 
tained by too long exposure to such intense heat without the safety 
valve of perspiration, there being danger of heat-stroke taking place. 
Most Turkish baths have a second or very hot room whose temperature 
ranges from 140° to 180°. After free perspiration has been induced, 
the bather may enter for a few moments the very hot temperature 
above mentioned in order to induce vigorous or excessive perspiration. 
From this chamber he enters the shampoo room, is placed upon a slab 
of marble with a rubber air-pillow under his head. The attendant 
usually commences by dipping his hands in very hot water, rubbing 
the entire cutaneous surface with his hands alone. He then shampoos 
the bather with soap, commencing with the upper extremities and 
systematically going over the entire body. This may be done with a 
brush of hair, rubber, flax or other fibrous material. This process is 
continued until all the superficial epidermis has been removed and the 
skin feels smooth and slick. The attendant then uses a small hose to 
which a nozzle with many perforations is attached to remove the soap 
and cleanse the body. He then proceeds to knead and roll the muscles 
of the upper and lower extremities and trunk, after which he again 
sprays the patient, gradually reducing the temperature of the water to 
about 80°. The bather is then conducted to the douche, which may be 
either the rain bath, circular needle or jet, and given a short vigorous 
cold application. He is then quickly rubbed down, a sheet is thrown 
around him and he enters the cooling room ; here the attendant starts 
with the head and carefully dries the hair, then in succession the 
extremities and trunk. It is likely that there will be secondary per- 
spiration after the patient enters the cooling room. If there is much 
difficulty in drying the hair, or perspiration continues, an alcohol rub 
is frequently added. The patient should remain in the cooling room 
until he is perfectly dry and pulse and respiration have reached 
the normal. He dresses slowly and avoids exertion for some time 
after the bath. 

The Turkish bath is a powerful procedure, and with the strong 
it may be used twice weekly ; with the feeble never more than once 
a week. This bath is a very ancient one, and was the bath of all 
others most in vogue by the Romans, the ruins of whose thermae 
to-day give some idea of the immense extent to which this luxurious 
race utilized the bath. This is especially true of the thermae of Cara- 
calla, which have heretofore been described. 

The Russian Bath. — The Russian bath is usually given in Turkish- 
bath establishments, a room being set apart for this purpose. In my 



82 PRACTICAL HYDROTHERAPY. 

opinion, it is the least valuable of all methods of applying heat by 
conduction. In this bath the patient lies upon a marble slab in a 
small room filled with the vapor of steam. The temperature is usu- 
ally kept between 115° and 125° F. It will be noted that the bather 
cannot stand high moist temperatures; in fact, 135° or 140° F. is 
trying to most persons. The bather, lying upon the slab, is rubbed 
by the attendant with a view of stimulating an active flow of per- 
spiration. The same rules that are applicable to the Turkish bath 
with regard to preparation and after-treatment apply with equal force 
to the Russian bath. 

Superheated Dry Hot Air. — The use of this measure is of recent 
date, and was first introduced about ten or twelve years ago in England, 
through what is known as the "Tallerman-Scheffield local hot air bath." 
The writer has before him the original communication (London Lancet) 
with regard to this method, and it is interesting to note the improve- 
ments that have been made in technique, apparatus and results, but 
justice must be done in giving credit to the original idea of these 
workers. To-day many kinds of apparatus are upon the market 
for the local and general application of high temperatures of dry 
hot air, but those used by the author, whose cuts are shown here- 
with, have always given him satisfaction and most excellent results. 
The essential basis of construction in the local as well as body appa- 
ratus is an arrangement by means of which very high temperatures 
of hot air may be made to circulate through a cylinder composed of 
copper, steel or other metal. The apparatus is so constructed that 
applications may be made to the body or extremities without the 
part coming in contact with the heated metal of the cylinder. 

In local applications, the part is carefully wrapped in Turkish 
toweling and covered with a glove or stocking made out of the same 
material. It is then placed in the hot-air apparatus upon a stand, 
marie usually of asbestos, the curtains being carefully drawn around 
the limb, so as to prevent the escape of heat. In practice the gas 
jet is first lighted and the apparatus allowed to warm up; the limb 
is then introduced as above described, and allowed to remain from 
thirty to sixty minutes, after which it is removed and treated. 

The body apparatus made by Betz is, in my opinion, the best 
apparatus upon the market, and. as is seen in the picture, it is a 
metal cylinder with a stretcher board rolling upon a metal track. 
In practice the patient, wearing a Turkish bath-robe, slips on a pair 
of mits an:! stockinettes made out of Turkish toweling,, a sheet of sim- 
ilar material is wrapped around him and then run in the cylinder, 
the apron neatly tucked and adjusted around the neck, and a wet 
turban or ice helmet placed upon the head, which is made com- 
fortable with the pneumatic pillow. The gas jets are then lighted 
(the writer uses natural gas) and the valves in the top opened. The 




Plate 33 — Superheated Dry Hot Air ; Treating Hip. 




Plate 34 — Superheated Dry Hot Air ; Treating Back. 



ASSOCIATED PROCEDURES. 83 

temperature of this bath, to obtain the best results, should range 
between 240° and 300° F., a fair average being 275°. Certain 
facts should be borne in mind in the technique, one of which is to 
be liberal in wrapping the body and extremities for these applications. 
Water must be accessible, so that the patient, should it be deemed 
advisable, can drink freely. The head is kept cool and the face 
sponged. Women may wear the gutta-percha cap, so that the hair 
will not become dampened, and upon the forehead and around the 
neck a cold compress is applied. Every endeavor should be made 
to make the patient comfortable. See that the chair or lounge in 
local applications is at the right height and producing no strain upon 
other joints ; in the body apparatus spare no pains to secure proper 
and comfortable elevation of the head. Do not permit hot air to 
stream over the patient's face. In plethoric men and women a cold 
compress around the neck is a valuable aid in relieving oppression. 
If there is no special reason for doing otherwise, the patient should 
lie upon the back, but where the aim is to treat conditions involving 
the spine or back muscles the patient may recline upon the abdomen. 
It is advisable from time to time to raise the limbs without uncovering 
them, in order to secure free circulation of the hot air about the en- 
tire person. The duration of this bath ranges from twenty to sixty 
minutes, with temperatures of 240° to 300°. When the treatment is 
over the apron is thrown aside and the stretcher rolled out to its full 
length. It is generally my plan to then permit the patient to recline 
upon the sofa or massage-table for a few moments. Usually there is 
a fresh accession of perspiration upon leaving the apparatus. At 
this point, general massage, vibration, etc., may be applied. The 
author, when using the body apparatus, never uses either, but prefers 
to have the patient enter a needle or circular rain bath at a tem- 
perature of 100°, which is gradually reduced until sufficient heat 
abstraction has taken place. Reaction occurring, the patient is then 
rubbed down, and allowed to rest until perfectly dry. It has been 
my experience that these treatments are most successful when exer- 
cise is not taken immediately after them, but rather they should be 
succeeded by rest. First treatments should be of short duration, so 
that we may have an opportunity of studying the patient's reactive 
capacities. Increase gradually each succeeding treatment. Many 
patients can bear much higher temperatures where the head and neck 
are kept cool, and it may be reiterated here that comfort soon over- 
comes nervous dread and apprehension. It is astounding sometimes 
what tactful management of cases will do to overcome a patient's 
fears. 

Therapeutics.- — There is a wide therapeutic field for this method in 
many kinds and classes of diseases. Care should be taken, however, to 
investigate carefully the condition of the circulation, heart and respira- 



84 PRACTICAL HYDROTHERAPY. 

tion. Many cases that can stand the hot-air cabinet and superheated dry 
hot air cannot endure or gain benefit from the use of the Turkish or 
Russian bath. 

Superheated dry hot air is not as good a method as the electric 
light bath for warming patients before the use of cold applications. 
This is equally true of the steam vapor cabinet. In rheumatism, gout, 
arthritis and the uric acid diathesis it should be more utilized than 
it is at the present time, especially where followed by hydriatic meas- 
ures which tend to produce tonic conditions of the circulation. 

The Turkish bath and body apparatus of superheated dry hot air 
are excellent methods for the reduction of obesity, and the author has 
obtained benefit in diabetes from their use, combined with Swedish 
resistive exercises. In diseases of the kidney, where these organs are 
crippled and elimination is defective, superheated dry hot air has 
yielded me results far beyond my anticipations, though care should 
be exercised in subsequent cooling. In constitutional blood states, 
metallic poisoning, scrofula and syphilis, excellent results may be 
expected. Superheated dry hot air has, in my hands, given results 
more nearly resembling the hot springs of this country and Europe 
than any other treatment. In general infective conditions, in acute 
inflammations of the lung, pleura, intestines, etc., superheated dry hot 
air is indicated. In chronic nervous diseases, neurasthenia, hysteria, 
neuritis, neuralgia, functional rather than organic troubles are bene- 
fited by the hot-air cabinet and superheated dry hot air. Nervous 
patients do not, as a rule, stand the Turkish bath well, but take the 
same temperatures, where the head is exposed, with impunity. In 
myelitis the judicious use of dry hot air is valuable, but I wish 
to enter a strong protest against the use of these measures in loco- 
motor ataxia, spinal and cerebral paralysis, etc. Chronic dyspeptics 
of all kinds are helped by hot air or superheated dry hot air; the 
anemic and chlorotic also. For the elimination of mercury there is 
nothing, in my mind, comparable to the action of the body apparatus 
and the incandescent electric light bath. As a means of preserving 
health, strengthening the resistive powers against the encroachment 
of disease, and for overcoming the results of a sedentary life, these 
methods are of considerable value. 

The local application of superheated dry hot air has proved by 
far the most satisfactory means for the treatment of the joint 
affections that accompany gout, acute or chronic articular rheumatism, 
synovitis, fibrous ankylosis, sprains, rheumatoid arthritis, joint tuber- 
culosis, etc. In localized infections its influence is almost marvelously 
curative. 




Plate 35— Hot Air Cabinet. 




Plate 36— Hot Air Cabinet in Use. 



CHAPTER VI. 
MINOR HYDROTHERAPEUTIC METHODS. 

The methods described in this chapter have in themselves only 
moderate curative value, and are therefore classified by me as "minor 
hydrotherapeutic methods." They are, however, very useful for the 
temporary relief of localized inflammation and functional pain. Many 
are daily utilized by the laity, who apply them without consultation 
with the physician. They possess little, if any, systemic influence. 
The commonest application is that of heat, which may be applied by 
means of the hot-water bag, bottle, jug, sand-bag, salt-bag, bran-bag, 
bricks, blocks of wood, stove lids, flat irons and coil — in fact, almost 
any way in which heat can be retained. All objects used should be 
wrapped before applying The immediate effect of localized heat is 
to gradually raise the temperature of the part brought in contact 
with it, the part to which heat is applied being warmed to a consid- 
erable depth. Circulation is increased and the temperature slightly 
raised by dilatation and increased activity of the blood currrent. 
Metabolism is stimulated, exudation and suppuration favored. Its 
action upon the nervous system is that of a sedative, relieving pain 
by its combined influence upon the cutaneous nerves, relieving pres- 
ure and relaxing muscles. 

Local cold effects are the reverse of those of heat, with some few 
exceptions. The local application of cold does not influence the gen- 
eral body temperature nor produce general effects. It reduces the 
temperature of the part until it reaches that of the thermic medium, 
lessening the circulation in the part, reducing temperature by con- 
tracting the blood-vessels and slowing the blood-stream. Exudation, 
pus formation and metabolism are retarded. Upon the nervous sys- 
tem cold may likewise produce a sedative influence, due to its numb- 
ing action upon the nerves within the skin. Especially in those pain- 
ful states produced by localized inflammations we may expect con- 
siderable relief from the application of cold. There is one localized 
application of cold, however, that may produce a general lowering of 
the temperature, and this is the much-used cerebral coil or coil cap. 
This consists of a thin rubber basis upon which is wound a rubber 
tube through which the water flows. The cap is adjusted to the head. 
The general reduction of tempertaure is due to its influence upon 
the thermogenetic centers located within the brain. This is one of 
the reasons why it tends to lower temperature in meningitis, in addi- 
tion to its localized action as an abstractor of heat. 
(85) 



86 PRACTICAL HYDROTHERAPY. 

Heat and cold may both be applied to any part by simply wrapping 
around a small rubber hose attached to a proper reservoir which 
permits the flow of water through the tube. All localized applications 
of heat and cold are better tolerated where a thin compress is placed 
between them and the skin. 

Chapman's Methods and Bags. 

At the head of minor hydrotheraeputic measures stands the appli- 
cation of ice and hot water to the spine, first brought to notice by Dr. 
John Chapman, of Paris, France. I had the pleasure of knowing 
Dr. Chapman during my sojourn in Paris in 1889. and was in this way 
early brought in close touch with his ideas and work. From time 
to time since then I have utilized his methods. My own experience 
with regard to the efficacy of his treatment is to substantiate the prop- 
osition laid down by him in his works, but I have so far not been 
able to secure the curative results that he claims for the persistent 
application of the method. The essential feature is the use of a single-, 
double- or three-compartmented rubber ice-bag, these compartments 
being superimposed upon one another with the idea of preventing 
the accumulation of ice at the lower part of the bag alone. The^e 
bags are of sufficient width — say about four inches — to cover the en- 
tire spinal area, embracing, as he says, the spinal cord itself and the 
sympathetic ganglia lying adjacent to it. 

The sympathetic system consists of a series of ganglia connected 
together by intervening cords, extending on each side of the vertebral 
column from the base of the skull to the coccyx. There are a num- 
ber of ganglia of this character associated with the cranial nerves. 
Each ganglion may be regarded as a center from which branches and 
impulses pass in various directions. These ganglia are intimately 
connected with the organic processes of life, and follow the blood- 
vessels to their finest ramifications. The cut gives at once a bird's-eye 
view of the distribution and physiological association of sympathetic 
nerves. Independent functions are found in connection with the 
nerve plexuses formed by the junction of numerous branches of 
nerve fibers into a central ganglion in different localities. These 
nerves and plexuses are connected intimately with the central nervous 
system. They govern the so-called organic functions of the heart, 
abdominal viscera, especially those of the stomach, intestine, uterus, 
Fallopian tubes, etc. It will be borne in mind, however, that as far 
as its vasomotor function is concerned this is derived from the cen- 
tral nervous system and passed into the plexuses, and that the nerves 
originating from the plexus carry these impulses to the terminal 
blood-vessels. 

It is Chapman's theory that ice applied in rubber bags of the right 




Plate 37— Chapman's Spiral Ice Bags; Chapman's Double Column Spinal Hot 
Water Bag; Ordinary Hot Water Bottle. 



MINOR HYDROTHERAPEUTIC METHODS. 87 

length and proper width, placed over the sympathetic centers located 
in the spinal column, dilates the arterioles controlled by the said cen- 
ters, arrests hypersecretion of glandular organs, checks spasmodic 
and irregular muscular movements of the voluntary and involuntary 
muscles, and by its sedative action upon trophic centers arrests hyper- 
nutrition. The action of heat is diametrically opposed, viz., it con- 
tracts the arterioles, increases the secretion from the glandular sys- 
tem, increases muscular movement, voluntary and involuntary, and 
by its action upon the trophic centers increases nutrition. He 
says : "But as the sympathetic and cerebro-spinal nervous systems are 
so intimately related, and, indeed, inextricably and undistinguishably 
blended, both in structure and function, the nervous influence, whether 
in health or not, which is exerted becomes abnormal, either in kind 
or degree, the most satisfactory method of restoring it to its healthy- 
condition would be by a dual action at once on the sympathetic and 
cerebro-spinal nervous systems." 

Chapman states his pathology as follows : "That the so-called func- 
tional diseases of any viscus are abnormal conditions of the nervous 
ganglia which control it, and that these diseases are most safely, most 
easily and most evidently remedied by action not on the viscus itself, 
not by medicine presumed directly to influence it, but by decreasing or 
increasing the quantity of blood in those nerve centers by which its 
blood-vessels are governed." 

In practice the patient lies upon the ice-bag for periods varying 
from one to two or three hours in duration, according to the severity 
of the condition. It must be borne in mind that this is not a method 
for the local effect of cold. Cold is not disagreeable, as I have 
frequently demonstrated upon myself. The application of heat is 
accomplished by a double-column hot-water bag with an intervening 
space between the columns, the heat being applied upon either side 
of the spinal column itself. The temperature of the water should 
be between 115° and 120° F., and may be applied for the same length 
of time as the ice-bag. Its greatest range of action lies in functional 
nervous diseases, and Chapman recommends this for nervous pros- 
tration, headache, migraine, insomnia, indigestion, vomiting, consti- 
pation, leucorrhea, bronchorrhea, asthma, hay fever, etc. It is claimed 
by him to be useful in the treatment of neuralgias, especially of the 
face. I cannot agree with him in the uses and value of this treatment. 
but it has, in my hands, yielded some results in the treatment of in- 
somnia, in which condition the application of a dorso-lumbar ice-bag 
has frequently produced drowsiness. This can be increased by the 
application of the hot-water bag to the "cilio-spinal region" — that 
is to say, from the fourth cervical to the third or fourth dorsal of the 
cord. As before stated, these applications have aided me in the pro- 
duction of sleep, but I have never been able to demonstrate their 



88 PRACTICAL HYDROTHERAPY 

curative power. They, however, are excellent measures for tempo- 
rary relief. 

Friction. 

Friction may be denned as the mechanical act of rubbing the cuta- 
neous surface. It may be performed by the hand, flesh-brush, or 
flesh-mitten, but the first of these is far preferable to any other form. 
It is synonymous with the word shampoo as used in medicine. It may 
be applied by the individual or, preferably, by an attendant. The or- 
dinary manner of its application is to rub the skin surface with the 
bare hand, preferably in both directions. The condition and sensi- 
tiveness of the particular individual in question will decide the depth 
and pressure used as to whether it will be light or vigorous. Avoid 
applying such an amount of friction as would irritate the skin or 
abrade it. Nothing is gained by rough or irritating treatment. This 
is much more likely to occur where a brush is used than where the 
hand is interposed. Where the hand or brush has been used too 
much, superficial redness and irritation are apt to follow. Too vigorous 
application defeats its own object, and has a tendency to exhaust and 
tire the patient. See that the hand is perfectly dry. Where it is 
used simply to assist the circulation, it may be applied only in the di- 
rection of the venous blood current — that is. toward the heart. The 
first influence of friction upon the cutaneous surface is a very pleasant 
one, its momentary action being to temporarily constrict the capillary 
circulation, but after it has been kept up for a short time dilatation of 
the blood-vessels occurs, and it is for this reason that friction favors 
reaction. The volume of the circulation is considerably accelerated, 
with a moderate increase of the pulse. Owing to the mechanical 
action of friction and to the dilatation of both the arterial trunks and 
capillaries, there is a slight rise in temperature, together with an in- 
creased production of heat, a fact that is clinically utilized in the 
Brand bath, the half bath and the dripping sheet. Winternitz dis- 
covered that active friction of the skin, combined with the application 
of cold water, increases temperature reduction, this being accom- 
plished by bringing a larger quantity of blood to the surface, circu- 
lating in contact with cold water. This dilatation of the blood-vessels 
is very marked in some instances, and can be cultivated by the 
repeated use of friction. 

The influence of friction upon the skin is a valuable one, stimula- 
lating it to secrete more actively of perspiration, and particularly of 
the oily constituents connected with the sebaceous glands. It tends 
to produce a soft, flexible and smooth skin ; it also increases the hairy 
growth, and care should be exercised in this direction. The therapeutic 
uses to which friction may be applied form a part of every massage 
treatment. It is a splendid preparatory procedure to cold water, and 




Plate 38 — Friction with Flesh Brush. 



MINOR HYDROTHERAPEUTIC METHODS. 89 

where one does not have handy the electric light or hot air bath this 
may be used with the same object in view. It is useful as a pre- 
liminary for these cases who are confined to their room, and with 
whom we would use the dripping sheet or some similar method. To 
the hydriatist it is the best of all means for the favoring of reaction, 
and should never be omitted from any method where this is desired. 
Applied to cold extremities it stimulates circulation. I will have more 
to say regarding its use when considering the physiological action of 
the Brand bath in typhoid fever. 

Sand Baths. 

I have never utilized this method of treatment in my practice, but 
have incidentally tried and observed its action at the seashore. I do not 
consider sand nor mud baths to possess any special therapeutic value 
over ordinary hydriatic methods. They do not, in any sense, compare 
to the application of radiant heat, such as the electric light bath. Of 
these baths YVinternitz 1 has to say the following : 

"Originally sand heated by the sun was employed, but the method 
has been accelerated in recent years, especially by Dr. Sturm, of 
Kostritz, and by Grawitz, of Berlin, and its indications have been 
defined. At present artificially warmed, fine, hard sea or river sand 
is used, the heating being effected in ovens especially constructed for 
the purpose. In the tub — a quadrangular wooden box upon rollers — 
is placed a layer of hot sand from 15 to 30 cm. (six to twel /e inches) 
high, and upon this the patient lies. With the exception of the head, 
which is elevated, the body is covered with sand, and finally with 
warm blankets. The floor of the cabinet is generally made of sheet- 
iron and is heated by means of tubes placed below. The sand has a 
temperature of from 45° to 50° C. (113° to 122° F.), and even a 
temperature of 53° C. ! 127.4° F. ) is well borne. The pulse, it is 
true, becomes accelerated, as in the case of other methods of over- 
heating the entire body ; and also the respiration is quickened, but 
serious discomfort is exceptional. The head must always be well 
cooled. Sweating occurs rapidly, and becomes abundant, as the sand 
exerts a hygroscopic influence, and favors the secretion of sweat. 
The sand bath is continued from one-half to one and one-half hours." 

Salt Rub. 

The application of salt to the cutaneous surface has been practiced 
for years by eminent hydriatists. Medium fine salt is moistened with 
sufficient water to produce a mushy mixture, after which it is taken 
in the hand of the attendant and applied to the surface of the body 
with circular friction movements. Care should be taken to rub gently 
and slowly so as to prevent scratching or abrasion of the skin, as some 
individuals are exceedingly sensitive to the scratching influence of 
this chemical. Persons with a dark, tough cutis may be rubbed vigor- 



1 Winternitz, Wm. : "Cohen's Systeir of Physiological Therapeutics." Vol. IX, 1902. 



90 PRACTICAL HYDROTHERAPY 

ously until they begin to feel strongly its action upon the integument. 
The water used to moisten the salt, and the salt itself, should be kept 
at such a temperature as will avoid chilling of the surface. In 
sanatoria these applications are made in properly heated treatment 
rooms, and thus it is not necessary to exercise as much care to prevent 
chilling. Where the patient is weak he may sit or recline during its 
application. Considerable amounts of the salt will stick to the skin, 
and if it is permitted to dry will produce an itchy feeling. Its applica- 
tion may be followed by any hydriatic method suited to the particular 
case. The patient can then be dried and gently rubbed with the hand 
to favor reaction. After the application of the salt rub the skin feels 
smooth and glossy, a great deal like the condition following a Turkish 
bath, due to the removal of several layers of the epidermis. The 
physiological action of the salt upon the skin is that of a chemical, 
thermic and mechanical irritant. Under its use the skin becomes 
redder and more vascular. Its application alone resembles the salt 
water bath, and is quite tonic and stimulating. Care must be used 
with sensitive neurasthenics. It is a valuable introductory method to 
other hydriatic procedures, and is particularly beneficial in those cases 
who have dry, harsh and leather-like skins. In some cases of digestive 
and renal inactivity this measure is an excellent derivative. I have 
found it to render service in removing localized pains of a neuralgic 
and rheumatic type when situated in the muscles and joints. I 
frequently prescribe the incandescent electric light bath with localized 
applications of salt to painful spots, these measures to be followed by 
some general hydriatic treatment. 

Oil Rub. 

From most ancient until the present time oil has been used as a 
method of treatment after the use of the bath. It will be recalled that 
one of the divisions of the Roman bath was that of the unctorium, 
where oils were "rubbed in." It is a constant practice with semi- 
civilized and barbaric races to use oil after the bath, for protective 
and cosmetic purposes. The best oil to apply to the surface is a 
vegetable one, and for this purpose cocoanut and olive oil have proved 
the best in my hands. Cocoa butter and vaseline may subserve the 
purpose, especially the former. From an esthetic standpoint the 
addition of a little oil of rose is not objectionable. Care should be 
exercised in securing fresh preparations, and seeing that there is not 
the least degree of rancidity. The best method of application is by 
means of the palmar surfaces of the fingers and hand. It should be 
applied to the skin after a thorough cleansing bath. The skin must 
be dry and free from perspiration. This must not be considered a 
greasing process, but the oil is to be gently and patiently rubbed into 



I 

in 



70 



a 

5" 





MINOR HYDROTHERAPEUTIC METHODS. 91 

the skin. Unguents are not applied to the skin for the purpose of 
nourishment. 

Some of the effects associated with massage are inseparable from 
the application of the oil rub. Oil rubbing is an exceedingly pleasant 
and agreeable process where it is gently practiced. Its action upon 
the skin is to soften and make flexible this organ. It is sedative and 
is to be recommended for those cases who are so sensitive as to pre- 
clude the use of salt or vigorous dry friction. "The natives of 
Samoa and other south sea islands, who are great swimmers, habitu- 
ally smear themselves with oil before entering the water. On the 
other hand, heat radiation by the skin is very considerably increased 
by the application of oil. Peclat has shown (Schumann) that an 
oil surface radiates heat 50 per cent, more rapidly than a water 
surface. The natives of Africa, when exposing their nude bodies to 
the dry rays of the tropical sun, habitually protect themselves by 
smearing the skin with melted fat of some sort." (Kellogg.) 

Attention may be called to the fact that the Sandwich Islanders, 
who are probably the greatest swimmers known, not only smear them- 
selves with unguents while in the water, but . should one of their 
members become fatigued utilize friction to overcome this. 

The therapeutic application of oils to the surface is narrow and 
limited. It finds its greatest use in those persons whose skins are 
harsh and dry because of a lack of sufficient natural oil in the seba- 
ceous glands. Children seem to be more favorably affected by oil 
rubbing than the adult, though I am rather constrained to believe 
that it is more particularly the massage or rubbing than the physio- 
logical action of the oil. In the vigorous massage of localized con- 
ditions it is preferable to use some oil to prevent chafing and irritation. 
Many writers suggest the use of oil of some kind to the hair after 
the use of soap. Patients whose reactive capacity is limited gain 
some benefit from the application of oil rubbing after the bath is over. 

The Electric Bath. 

The electric bath is only used in the treatment of such morbid 
conditions as affect the whole system, and provides a convenient 
though unsatisfactory way of applying electricity. Electrification has 
a powerful influence upon the body, and is useful in the treatment of 
general morbid states and in diseases due to impaired, defective nutri- 
tion. The temperature of the water should be about 98° F., but it 
may be slightly warmer or cooler to suit the wishes of the patient; a 
bath thermometer must always be used to ascertain and regulate the 
temperature. The bath-tub itself may be porcelain-lined, metal, papier 
mache or wood, with two electrodes in the form of metal plates at 
the head and foot. These plates must be kept scrupulously clean and 
the wires attached by binding posts. The water in the bath offers a 



92 PRACTICAL HYDROTHERAPY. 

broad conducting medium several times larger than the patient, and 
therefore a considerable part of the current traversing the water is 
lost to the patient, this being particularly true of the galvanic bath. 

In the use of the galvanic current care must be taken to gradually 
allow the electricity to enter the tub until the milliamperemeter reg- 
isters from 100 to 150. Of this Stevenson and Jones" calculate that 
the patient only receives from 18 to 24 milliamperes. The best 
batteries to use are those of the Laclanche type, and of these I have 
found the Gonda the best on the market. Forty should be connected 
with a switch-board having a milliamperemeter, rheostat, pole changer, 
and binding post. The faradic coil may be added should the physician 
desire the combined galvano-faradic current. 

The patient enters the bath and rests a few minutes to recover 
from the reaction produced by the action of the warm water before 
the current is turned on. Gradually and slowly increase the current, 
watching the meter until the proper dosage is reached. It is best 
for a medical man to be present when the galvanic current is used, 
although a well-trained nurse will usually be able to conduct the 
seance; if it is necessary for a medical man to be present in the case 
of ladies a bathing costume should be worn. I formerly used the 
electric bath considerably, and at that time had it so arranged that the 
battery and switch-board were in an adjoining room ; a speaking- 
tube was carried to the bath-room and the current was, in this way, 
regulated. It is, however, best for the physician to be present and in 
the room while the galvanic current is flowing. 

A wet turban or ice helmet should be placed upon the head and 
care exercised not to take the bath too soon after a full meal. The 
action of the electric currents is to redden the nape of the neck, which 
gradually passes off after a short while. The alternating current or 
induction coil may be used, the alternating current producing a 
smoother sensation, the rise and fall of the individual impulses being 
less abrupt than with the coil. The induction coil current throws the 
abdominal muscles into action more readily than the galvanic current, 
and generally produces more muscular contraction. No one should 
attempt the giving of an electric bath from the "mains" unless he be 
what very few medical men are — an expert electrician. The sinusoidal 
current may be used in like manner. 

The therapeutic uses of the electric bath are those of a general 
tonic, and it finds its uses mostly in states of debility. Some have 
found it of value in alleviating the distress connected with the dis- 
continuance of morphine. Many have lauded this bath as a means of 
increasing appetite, digestion and assimilation, and have obtained re- 
sults far different from my own experience. After several years' 
experience with this bath I have discontinued it as one of my thera- 

2 Stevenson and Jones: ".Medical Electricity," 1895, p. 268. 



MINOR HYDROTHERAPEUTIC METHODS. 93 

peutic weapons. It is described here in order that the work may be 
complete, and not from any desire to laud the method, which I consider 
of little or no value. If electrization is what is aimed at, there 
are so many more special methods, general and local, of obtaining 
results in this line that I heartily condemn the hydro-electric method. 
It has been the bath par excellence of the quack heretofore, and while 
it has been removed from that particular domain by the scientific 
researches of both Hydel 3 and Hedley, 4 still hydriatists in this country 
who have other methods that they may use rarely, if ever, turn to the 
electric bath. 

Steam. 

Steam and the vapor from boiling water have been used for years 
by the physician and laity for the purpose of inhalation. This is, in 
reality, not steam inhalation, but is the inhalation of air saturated with 
moisture and warmed by the admixture of steam. It can be produced 
from the so-called croup kettle, but also obtained as steam in those 
houses that are provided with steam heaters. As a rule, heat is inhaled 
for a short time, at certain periods during the twenty-four hours, and 
there is no question but what this agent has given great comfort 
and alleviated the suffering of hundreds of persons affected with 
acute and chronic conditions of the air-passages. The action of 
steam upon the air-passages is that of localized heat, heretofore de- 
scribed and needless to be repeated again. In catarrhal conditions 
of the nose and throat it finds its most useful application. Relief from 
inflammatory conditions of the throat may be obtained by the inhala- 
tion of air passed through an ordinary inhaling bottle, the hot water 
of which is saturated with compound tincture of benzoin. One of 
the great objections to its use is the necessity of its frequent repeti- 
tion. The ordinary duration of an inhalation should be about ten 
minutes. Its action is decidedly soothing and relaxing ; it aids and 
improves the circulation in the part to which it is applied. I have 
never seen any permanent benefit derived from its application to 
chronically inflamed tissues of the upper air-passages. 

Another method of treatment consists in the inhalation of 
steam from a receptacle to which it is conducted, and of such shape 
that the entire head may be exposed. Around the head a towel is 
thrown, the steam inhaled thus being brought simultaneously in contact 
with the skin of the face and the mucous membrane of the air- 
passages. The stimulating influence of heat internally is reinforced 
by the active vascular dilatation that takes place within the skin surface 
thus exposed, draining the collateral circulation. Relief is frequently 
experienced in a few moments. After the administration care should 



3 Hydel, L.: "Die Electrische Bader," 1896. 

4 Hedley: "Hydro-Electric Methods in Medicine," 1892 



94 PRACTICAL HYDROTHERAPY 

be taken to avoid the inhalation of cooled or cold air. The external 
application of cold water to the face and neck following such a method 
of treatment will decidedly prolong and enhance the blood vascular 
effects obtained. 

It is the custom with writers upon hydrotherapy to include within 
the domain of such a work a description of lavage, enteroclysis, 
vaginal and vesical irrigation. I have frequently felt that while these 
were truly hydrotherapeutic applications, still it did not seem to me as 
though they belong to the true domain of works of this kind, but rather 
are methods of therapeutics limited to particular specialties. The 
author therefore refrains from describing these procedures, and refers 
the reader to works upon diseases of the stomach and intestines, 
surgery and gynecology, wherein will be found proper descriptions of 
the technique and the aims and objects to be accomplished. 



CHAPTER VII. 
RULES, REGULATIONS AND PRACTICAL SUGGESTIONS. 

Even with a mastery of the principles, a thorough acquaintance 
with the technique and apparatus, there still remain certain practical 
suggestions that are the result of long experience and the handling 
of many cases and classes of disease. For this reason it has seemed 
proper to me that they should be laid before any one contemplating 
the use of hydrotherapy as a method of treatment. 

Probably the most important principle in the guidance of hydriatic 
treatment is to treat the patient in hand, the condition and not the 
disease with which he has been tagged. Given a number of patients suf- 
fering from the same disease, and we will, if we intelligently study each 
individual, change and modify the treatment to meet the particular 
necessity of each case. Furthermore, it should be constantly kept in 
mind — and that clearly, too — that there is resident in the patient's 
body a vital force, the vis medicatrix naturae, which, if it can be 
called into play, will cure. 

It is a condition precedent to success, before commencing a course 
of hydrotherapy, that the physician should be in possession of all 
facts regarding his patient. By this I do not mean a haphazard and 
loosely conducted examination, but a full clinical history, a thor- 
ough examination of heart, lungs, and especially the peripheral blood- 
vessels, supplemented by an analysis of the blood, urine, and, where 
necessary, the gastric juice, blood-pressure tests, etc. In considering 
the clinical history of a case due weight must be given to the nervous 
system, studying the vasomotor indications and needs. It is by just 
such careful and painstaking examinations that we avoid the un- 
pleasant effects of hydrotherapeutic applications. I recall with pleas- 
ure that in an experience covering eighteen years I have had few 
disagreeable results follow an application of this remedy, and believe 
that this has been the case simply because the rules here laid down 
have been followed. 

The physician is the only person by whom the treatment is to be 
mapped out in all its details and technique, though the hearty and intel- 
ligent co-operation on the part of the trained nurse and attendant 
will materially aid in securing results. In a nurse implicit obedience 
is an excellent trait of character, and implicit obedience, tempered with 
a little judgment, aids in securing results. Nurses in the hydriatic 
department of sanatoria soon learn how to handle patients who come 
(95) 



96 PRACTICAL HYDROTHERAPY. 

into their hands, and are able to note degrees and differences of 
reaction that are valuable to the changing of hydriatic prescriptions. 
Every nurse to whom these cases are entrusted should know thor- 
oughly the changes that constitute reaction. 

Should the detailed examination show the patient suffering from 
some form of organic trouble, especially some structural disease of 
the kidney ( Bright's disease), care must be exercised to arrange the 
hydriatic prescription with regard to the application of cold water. 
The timid neurasthenic and hysteric must, by patience, assurance and 
reassurance, be convinced of the advantages that accrue from this 
treatment. These patients are, as a rule, deficient in will power and 
capacity, and are apt to form aversions to certain kinds of treat- 
ment, even when carefully graduated to their needs. The thin 
and the fat need different methods, and their physical states should 
be taken into consideration in our prescription. The physically 
weak and exhausted should receive careful attention, as they have 
less muscular tissue for the generation of heat, and are, as a rule, 
anemic and toxic. 

In the management of those chronically invalided, who have run 
the gamut of medicinal therapeutics, whose systems are more or less 
saturated, so to speak, with medicines, time becomes an element of 
necessity in their treatment. Too frequently I am consulted and 
asked if a few weeks' course of treatment can overcome long-standing 
ailments. The system has become warped, pernicious habits and 
conditions of life formed, which not only have to be changed, but a 
sufficient length of time allowed to establish physiological reactions 
and rhythms, and this cannot be changed and adjusted in a few weeks' 
time. It is often a question of months. 

Of all the classes of patients that seek the hydriatist's aid, the 
most difficult to handle and those in whom more caution has to be 
exercised, is the class suffering from the symptom-complex called 
neurasthenia. They are sick all over, nervous, impressionable, irri- 
table, dyspeptic, toxic, with skins that are strangers to cold water. 
Caution must be exercised in the inception of any method. 

The hydriatist should pay particular attention to arterial sclerosis 
when placing his patients upon treatment. Age is not measured by 
years, but by cardio-vascular conditions, some persons being older at 
thirty than others at sixty. Especial care in cases of this kind should 
be insisted upon, as there is serious danger of the rupture of a brittle 
or weakened blood-vessel, and as these vessels are usually more 
commonly present in the brain, the danger of a cerebral apoplexy 
should not be overlooked. 

For esthetic reasons alone hydriatists, as a rule, forego the use 
of baths during the menstrual period. There exists in the minds of 
the laity a conviction that is firm and immovable that baths should 



RULES, REGULATIONS AND SUGGESTIONS. 97 

be discontinued or forbidden during this period. This is not limited 
alone to the ignorant and uneducated, but is prevalent among well- 
read and enlightened members of the community. Physiology fur- 
nishes no basis upon which to form such an hypothesis, and physicians 
are largely to blame for having nurtured this belief, which is due to 
ignorance of natural laws. I have read, though I am unable to put 
my hand upon the authority, that upon the Massachusetts coast is a 
colony of sturdy fisher people whose women enter the sea during the 
menstrual period, even during the dead of winter, without the slight- 
est ill effects. While this extreme is not applicable to the delicate 
and hot-house nurtured individual of the present generation, still it 
is true that they can be readily trained to endure without discomfort 
and with much benefit the application of cold baths at this time. As 
an actual fact, water stimulates intrapelvic circulation, and thus cor- 
rects and counteracts irregular and deficient menstruation. The time- 
worn and hoary legend that the contact of cold water to the skin 
during the menstrual period will cause cessation of the flow, is a relic 
of bygone days, and a reminder of the infancy of this treatment, be- 
fore the principles and physiology of the action and reaction of cold 
water were studied or appreciated. 

Hydriatic treatment should not, as a rule, be administered imme- 
diately after a meal, but a period of at least one hour or one hour 
and a half be allowed to intervene. As before stated, I have found 
the best period for administration of these methods of treatment to be 
during the forenoon, preferably two hours after breakfast and up to 
within a half or one hour of lunch or dinner. 

Metabolism should be carefully studied and the patient's weight 
watched, whether the aim is constructive or destructive. Much in- 
formation as to the general internal changes that take place may be 
gained from the feelings of the patient. An improvement in appe- 
tite, muscular strength, and that feeling described by our Gallic neigh- 
bors as bien faisance, constitute an excellent index. The solid con- 
stituents of the urine often give valuable aid, an excess of solids, es- 
pecially the chlorides, indicating increased tissue breakdown, while 
an excess in urea points to destructive metabolism taking place in the 
muscles, demanding a regulation of exercise and hydriatics. 

Extreme exhaustion contraindicates the use of cold applications. 
In these cases fatigue, chilliness, blueness of the extremities and 
cold sweat may be present. Under such conditions it should be our 
aim to bring about reaction by the application of heat and heating 
procedures, and when this is fully established a brief stimulating 
and tonic application of cold can be made to ensure permanency. 

Organic diseases are, of course, from their very nature, incurable, 
but there are comparatively few organic diseases, excepting in the latest 
stages, that have totally destroyed the function of any organ or part. 



98 PRACTICAL HYDROTHERAPY. 

It has been my observation that the judicious, proper and painstaking 
application of suitable hydrotherapeutic applications prevent degen- 
eration and check further encroachment. It frequently occurs that 
if the remaining tissues are undisturbed by the process they will take 
up the work, and thus a part may be made to perform the work of the 
whole. It is common sense as well as sound logic, that whatever in- 
creases vital force, improves vigor and resistance, is certainly going 
to be a bar to further deterioration and incapacity. 

It may be noted again that reaction is that appearance of bright 
red color, an agreeable glow and sense of well-being that follows the 
application of cold. All nurses follow cold-water treatment by mod- 
erate friction to hasten reaction. 

In order to avoid disagreeable and ill effects of cold applications 
to the general surface, it is always well to carefully train the patient's 
reactive powers, collecting heat upon the surface and making the 
first cold application at a moderate temperature, say 80° F., reducing 
the temperature two or three degrees or more daily, as reactive ca- 
pacity develops. Never use strong measures at the start, but gradually 
work up from the milder to the stronger, from higher to lower tem- 
peratures, for by so doing much of the difficulties experienced by 
patients in these treatments can be avoided. As the patient reacts to 
each successive reduction of temperature, he soon becomes able to 
stand a temperature that would have been impossible and attended 
with danger had it been utilized at the start. The aim of tonic hydro- 
therapy is cold, and very cold, temperatures (65° to 45° F.), for it 
is from these temperatures that the most satisfactory and favorable 
effects are obtained. Reaction in nervously exhausted cases is best 
attained by brief, stimulating, cold applications. 

Preliminary or preparatory treatment for cold temperatures is im- 
portant, and must be carefully studied by the hydriatist. The electric 
light bath, hot-air cabinet, vapor cabinet, salt rub, friction or physical 
activity sufficient to produce slight perspiration, favor prompt and 
tonic response and the onset of reaction. 

Imperfect reaction is a disagreeable phenomenon that can attend 
the application of cold. This is, in the highest degree, an injury, and 
indicates failure to attain our object. The nurse first applies vigorous 
friction, assisted by the patient, for muscular exercise favors reac- 
tion; should this fail, the patient must be wrapped in blankets, hot- 
water bags placed to the feet, and very hot water sipped slowly. By 
this means imperfect reaction will be overcome. Where reaction 
takes place and it is not sufficient, it can be increased by moderate ex- 
ercise after the bath. The disagreeable after-effects of cold applica- 
tions are, generally, fatigue, muscular aching, lassitude, headache, de- 
pression, palpitation of the heart, irritability, and an increase in local- 
ized painful conditions. 



RULES, REGULATIONS AND SUGGESTIONS. 99 

Habit is the result largely of neural responses to certain impres- 
sions. Patients who have never formed the habit of using anything 
but hot water have missed the pleasurable portion of bathing, and 
these individuals must be trained to stand colder temperatures ; whereas, 
those who have been accustomed to the use of cold water may fre- 
quently be at once subjected to radical treatment, for in these the 
neural and vasomotor mechanisms are habituated and trained to those 
prompt responses that are the essential and basic part of reaction. 

The best time of day for the administration of hydriatics is, in 
my opinion, between the hours of 9 a.m. and 3 p.m. Certain proce- 
dures are best given before breakfast, others at bedtime, but, taking 
the vast bulk of tonic treatments, we may say that the above hours 
are the best. In the treatment-rooms located in large cities it is not 
an uncommon thing to give treatment in the evening, and, while this 
practice is objectionable, it is better than no treatment at all, but it 
is certainly second or third best. 

Care and attention should be given to the temperature of the treat- 
ment-rooms. The bath-room must be kept warm, and, in my opinion, 
80° F. even is not too hot. By this means the comfort of the patient 
is conserved and the warm temperature favors reaction. After the 
patient has been thoroughly dried, he should return to the rest- or 
dressing-rooms, which are kept at a much more hygienic temperature. 

It may be set down as axiomatic that the colder the water the 
shorter the duration ; the colder the application the more vigorous 
should be the percussion. Where this is borne in mind, excellent re- 
sults are obtained. For very cold applications (34° to 55° F.) the 
duration should not be over three to five seconds, applied under con- 
siderable pressure; where the temperature is cold (55° to 65° F.) the 
duration may be extended to a maximum of twenty seconds ; while 
for cool applications (65° to 80° F.) they may last as long as one-half 
to three-quarters of a minute. If temperature-reducing effects are 
aimed at, however, this rule will not hold good, but the application 
must be kept up for fifteen to twenty minutes and be attended with 
friction. In the administration of neutral methods in order to obtain 
sedation it is necessary that the application should be from twenty 
to sixty minutes. Under some circumstances these applications have 
been continued for days and weeks, notably in the series of cases pub- 
lished by Reiss. As before stated, the aim of neutral applications is 
the avoidance of thermic reaction. 

What is true of cool, cold, and very cold applications is also true 
of warm (96° to 98° F.), hot (98° to 104° F.) and very hot (104° F. 
and above) applications— that is to say, very hot applications should 
be of short duration, rarely exceeding half a minute, while the hot 
and warm applications may be correspondingly prolonged. 

Just as white looks whiter upon a black background, so we may 



100 PRACTICAL HYDROTHERAPY. 

obtain more stimulating and revulsive effects if we alternate tem- 
peratures, and this is particularly true when alternation is accom- 
panied with considerable pressure. Where stimulation of this kind 
is desired, and it is deemed expedient to make the application, heat 
should always be the temperature first applied. It can usually be 
borne from 104° to 120° F., lasting from fifteen to thirty seconds, 
and followed by a very cold application (55° to 40° F.) for three 
to five seconds, again the hot application, then the cold. By this 
means we obtain very powerful reactions. My personal experience 
has been that there is no method so capable of relieving deep-seated 
pain, especially of fibrous tissues and peripheral nerves. Applied in 
this manner to the spine, it is astonishing what a mulittude of activi- 
ties are reflexly aroused, and what far-reaching and satisfactory 
conditions are produced. Stiffness and ankylosis are very effectively 
overcome, provided they fall within the curable category. 

When the dripping-sheet and non-percutient methods are used, 
the patient must stand in a foot-tub of water, as hot as can possibly 
be borne. This does away with shock, is a comfort, and, while a 
small detail, will frequently overcome strenuous objection and reluc- 
tance. It favors reaction. 

Patients frequently experience a sense of constriction and weight 
upon the chest, together with an apparent "shutting-off of the wind," 
when first subjected to a cold application. In hunting for an explana- 
tion of this, I noticed it was their habit to keep the mouth tightly 
closed, breathing only through the nostrils. This can be easily over- 
come by merely opening the mouth wide and inhaling deeply when 
the cold water strikes the surface. 

Many cases have positive harm done them by courses of treatment 
administered at popular pleasure resorts or mineral springs. These 
springs are usually hot salines, and the patient is immersed in the 
hot full bath for periods ranging from ten to thirty minutes. As a 
result, sedation and weakness, together with a considerable break- 
down of tissue, take place, and harm is done to the bather. This 
is likewise true of those who resort too frequently to the Turkish 
or Russian bath. 

Mere age does not preclude the use of hydrotherapy as a reme- 
dial agent, but does determine in a certain way the kind of treat- 
ment, its temperature, duration and force of impact. This is equally 
true with regard to the young, and in this, as in a number of other 
things in life, extremes meet, and the same rule applies for the child, 
the infirm and the elderly. The aged and the young cannot stand 
extremes of temperature, and are slow to react at all times. Care 
should be exercised to examine the heart from time to time. Chil- 
dren under seven years of age do not well bear the application of 
very cold water, and the douche in all forms should be avoided. 



RULES, REGULATIONS AND SUGGESTIONS. 101 

The daily cold bath is an important aid to general development in 
growing children, and increases muscular vigor, energy and nerve 
tone. It prevents the development of neuroses in young persons 
just entering upon puberty, relieves so-called growing pains, and pro- 
motes vigorous and normal development. 

We are frequently told by patients that an application of cold to 
the cutaneous surface results in a slight attack of rheumatism or a 
"fresh cold." These pains are not, as is commonly supposed, due to 
the shock of the cold water or to catching cold, but are more often the 
result of the setting free of uric acid and toxins of the uro-toxic group. 
These are absorbed into the circulation, produce irritating effects, dull 
aching pains and stiffness. It has been my habit for a number of years 
to be careful to see that patients are dried with especial thoroughness 
before leaving the bath-room during the winter months. They should 
exercise sufficient care to see that the skin is not damp before exposing 
themselves, for the colder and drier air of winter is very apt to cause 
rapid evaporation of the surface moisture, giving rise to chilliness and 
being followed by the so-called "cold." 

Hydrotherapy offers to those in health an excellent and effective 
method for the maintenance of sound and physiological function. The 
average human has a pure inherent objection to the use of cold water, 
and for this reason is apt to employ neutral, tepid or hot baths solely 
for the purpose of cleanliness, thus missing a great deal of the hygi- 
enic and tonic properties of the bath. Cold water is a tonic to both 
the central nervous and sympathetic systems. Cold bathing develops 
a flexibility of the vasomotor system and a vital resistance in the 
skin. I know of no better way of preventing or overcoming the 
tendency to "catch cold" than the cold bath. This is not brought 
about by "closing up the pores" of the skin, but is due to an increase 
in vital resistance, to greater flexibility of circulation in the skin, 
and the ability of the vasomotor mechanism to respond to cold im- 
pressions and reheat the skin. 

It is an interesting fact that I have observed time and time again, 
that patients frequently have their condition very much aggravated 
during the first few weeks of treatment, a state trying to them, and 
a period during which the physician is subjected to somewhat of 
a strain in maintaining his authority and retaining their confidence. 
This is especially true of those who are sick all over, whose every 
functon is involved, and who have little, if any, vitality as a margin 
upon which to build. This includes the neurasthenic, the dyspeptic, 
lithemic, the so-called "chronic invalid" — in fact, the flotsam and 
jetsam of therapeutics. At first the problem seems peculiar, and to 
the patient distressing. It is probably due to the fact that the treat- 
ment has thrown toxic material into the blood in excess. It is a good 
plan, therefore, to warn patients before they start that they may 



102 PRACTICAL HYDROTHERAPY. 

experience an intensification of their symptoms, but that these will 
disappear with perseverance in the treatment. Haig explains this 
condition on the hypothesis of the presence in the blood of an excess 
of uric acid (uro-toxic group), and that the increased symptoms will 
disappear with the elimination of these toxins. This is doubtless, 
in part, true. 

The ideal progress toward recovery is the gradual and steady ces- 
sation of symptoms and betterment of condition. This is rarely ob- 
tained. There are three modes of recovery under the application of 
these methods. The first is a steady, unbroken and satisfactory prog- 
ress ; the second a zigzag, irregular course ; and the third in which 
there is a sudden improvement after a prolonged perseverance in the 
treatment. These last cases obtain results by a sturdy confidence in 
their physician, a courage born of belief in his capacity. Not only 
is it necessary for the patient to persevere sufficiently long to secure 
results, but it is essential that the treatment be maintained some time 
after recovery. It is not sufficient to simply secure an amelioration 
or disappearance of symptoms. This lack of care on the part of the 
sick to secure permanent results explains many of the relapses re- 
corded against certain methods of treatment. 

Patients who have been chronic invalids for a long time have 
formed pernicious functional habits, and after recovery are more liable 
to the action of the causes that before produced the disease. For 
this reason they should exercise every hygienic precaution, and among 
the preventive methods is the use of cold water as a part of the pa- 
tient's daily life. By so doing he is able to guard himself against the 
action of these causes. 

Cases frequently do not receive the maximum benefit while they 
are under the immediate care of the hydriatist. There may be an 
amelioration and betterment of the symptoms, but a cure does not 
take place until after the patient returns to home surroundings. Thus, 
oftentimes, hydrotherapy is not given its full meed of praise for the 
excellent work it has accomplished. 

The majority of people in health, and especially those who are 
sick, have to be coaxed to take a bath — that is to say, to use cold 
water. Cold water usually means tepid, and very few of their own 
volition use a temperature under 80° F. These cases can be made 
to respond to the lowest temperatures. 

Sedentary persons especially need the benefit of the cold bath. 
Such persons may advantageously employ, before the cold douche, 
a hot bath of three or four minutes' duration. Adults who are pre- 
disposed to rheumatism, gout, gravel, migraine, Bright's disease, neu- 
rasthenia, and other maladies which for the most part are the result 
of the retention within the body of the products of nitrogenous waste, 
are benefited by the employment of the cold daily bath. Cold-water 



RULES, REGULATIONS AND SUGGESTIONS. 103 

treatment is especially useful for women of civilized nations, because 
of the deteriorating influence of their artificial life. The harmful 
customs of civilization, rather than nature, have made woman "the 
weaker vessel." The cold bath gives nerve tone, combats nervous 
weakness, is a most excellent prophylactic against hysteria, and to a 
very considerable degree overcomes the unwholesome tendencies of 
the in-door and sedentary life to which most women are subjected. 
The cold bath favors the development of the menstrual function in 
young girls, and, if habitually employed, normalizes the menopause. 

There are certain groups of patients whose skins are, hydrothera- 
peutically speaking, foreign to water, not that they are uncleanly. 
These people are benefited by all sweat-producing methods when suf- 
ficiently prolonged. The heat and sweating soften and loosen the 
dead and horny superficial layers, which are easily removed by the 
subsequent hydrotherapeutic application and mechanical friction. As 
a result, the openings or mouths of the various excretory ducts open- 
ing upon the skin are freed from their superficial coverings, and the 
accumulated waste material — fat, dirt and dried perspiration — re- 
moved. Opportunity is given for elimination, which these cases need 
so badly. 

Persons whose sedentary occupations confine them largely within 
doors, who work a great deal by artificial light, can maintain health, 
tone and vigor by the use of a sweating procedure and hydrotherapy 
twice weekly. I know of no more pernicious and dangerous method 
of following the above suggestion than the use of the so-called "home 
vapor cabinet." The trouble does not lie in the cabinet or in the 
method, but the individual using it is unwilling to follow the sweat- 
ing by a cold application of sufficient length to remove from the skin 
the increased heat imparted. For this reason there is no vigorous 
thermic and circulatory reaction, the real, essential object aimed at in 
the bath. In cold applications we have a means by which oil may be 
applied to the wheels of human health and the machinery made to 
run smoothly. 

One of the most valuable and interesting of all the actions of water 
in therapeutics is the influence it exerts upon the circulation, with the 
resultant reaction. Where the effect is general it is more or less 
valve-like in action, drawing a large quantity of blood to the cutane- 
ous surface from the interior of the body, especially the viscera. 
Nearly all disease starts in a disordered circulation, and he who has 
control of any means by which he can influence its action has a valu- 
able weapon with which to combat and cure diseased and disordered 
states, for chronicity is oftentimes maintained by circulatory dis- 
turbances or by the states produced in the body dependent upon these 
disturbances. Stasis of the circulation forms a favorable nidus or 
point for infection or the development of metabolic conditions favor- 



104 PRACTICAL HYDROTHERAPY. 

■able to disease, while, on the contrary, the favoring of a rapid circula- 
tion and the passage of a larger quantity of blood through any par- 
ticular organ stimulates its function and regeneration. 

In the anemic, care should be exercised to precede all hydriatic 
treatment by some heating procedure. In my hands the electric light 
bath has yielded the best results, the patient being kept in this long 
enough to heat the skin thoroughly, or until perspiration is barely 
perceptible to the touch. Better results will be obtained if the full 
strength of the bath is used for a short period. 

Acute inflammatory conditions, as a rule, contraindicate the use 
of stimulating or percutient measures ; chronic inflammatory condi- 
tions, notably those of neuralgia, myalgia, chronic rheumatism and 
chronic neuritis (especially of the sciatic nerve), require strong and 
vigorous ones to bring about the desired result. 

Secondary sedation of the nervous system is nearly always obtained 
through the influence of hydrotherapy, but where direct sedative ac- 
tion is desired this is best obtained by the use of the neutral bath 
continued for periods ranging from thirty to sixty and even ninety 
minutes. The aim in this bath is to avoid all the stimulating influ- 
ences that take place with reaction. Care should be exercised not to 
employ friction after the bath; dry the patient as rapidly and as 
gently as possible. Secure dryness, if possible; if perspiration takes 
place, evaporation causes chilliness, and the effect of the bath is 
defeated. The evil effects of the neutral bath are chilliness, exhaus- 
tion, headache, nervousness and irritability. I cannot speak with the 
enthusiasm of some writers upon the benefit of the neutral bath for 
the relief of insomnia. It has given some good results, but usually 
the patient has been one who possesses very strong and active circu- 
lation. 

Among sedative procedures, especially for the relief of insomnia, 
may be recommended the cold full wet pack at a temperature ranging 
from 75° to 65° F.. it having proven, in my hands, the most satisfac- 
tory method. 

There is a popular superstition that organic heart disease abso- 
lutely precludes the utilization of hydrotherapy. This is very far 
from the truth, as I have demonstrated too frequently in my practice. 
Care must be exercised, however, to most cautiously and carefully 
train the patient to stand hydriatic procedures, very mild in their 
nature at first, but gradually changed and adapted to the improvement 
that takes place. It is my rule to never give these cases very low 
temperatures nor very great pressure stimulation, and to sedulously 
avoid the application of even moderately cold percutient measures to 
the chest and abdomen. As will be seen, by means of the Schott 
method of baths and exercise, organic heart disease may be cured. 
In functionally irritable and weak hearts it is my policy to follow 



RULES, REGULATIONS AND SUGGESTIONS. 105 

practically the same method of training, but the time required to tone 
and strengthen cardiac activity is naturally very much shorter than 
in cases of organic trouble. 

Speaking In general terms, chronic diseases of the skin present 
certain obstacles to treatment by means of water. If suppurating boils, 
pimples or acute eczema are present, it has been my experience that 
heating procedures, followed by neutral or tepid applications, give the 
best results. Where these conditions are localized or circumscribed, we 
should proceed with the treatment as though they did not exist. Where 
it is important to prevent the water reaching the circumscribed con- 
dition, the covering of the parts with oil silk and a bandage permits 
us to utilize all the advantages of hydrotherapy without injury to the 
localized eruption. Acute eruptions of the uric-acid or auto-toxic 
type are benefited by hydrotherapeutic applications. Localized irri- 
tations, pimples, small boils, etc., frequently appear under compresses; 
this can be prevented by keeping the compress clean ; nothing equals 
simple boiling. 

It should be the aim of the hydriatist while prescribing for his 
patients to inculcate proper hygienic laws, and at the same time to 
insist upon the copious or free drinking of plain water where indi- 
cated. In like manner it is needless to state that it is an excellent 
time and hour for the cessation of stimulants, narcotics and their 
like. 

In conclusion, bear in mind the fact that Baron Liebig, fifty years 
ago, observed that "cold air, cold water and exercise, habitually em- 
ployed, are the most powerful of all means of stimulating tissue ac- 
tivity." For the sake of condensation and ready reference the fol- 
lowing table is appended : 



Rath. Temperature, Average Teni- Duration of Bath. 

Degrees F. perature. 

1. Sponge bath 50-70 60 No fixed time. 

2. Cold compress 34-50 40 Until warmed. 

3. Cooling compress 60-70 60 Until warmed. 

4. Stimulating compress ... 50-70 60 Until dry. 

5. Hot compress 110-130 120 Until cooled. 

6. Dripping sheet 50-70 60 3 to 5 minutes. 

7. Hot fomentation 120-160. 140 No fixed time. 

8. Dry full pack Warm — Until sweating. 

9. Hot wet pack 120-130 125 y 2 to 1 hour. 

10. Cold wet pack 40-70 60 Y A to 1 hour. 

11. Affusion 50-70 60 y 2 to 1 minute. 

12. Hot foot bath 105-120 110 5 to 30 minutes. 

13. Cold foot bath 50-60 55 1 to 5 minutes. 

14. Hot sitz bath 105-120 110 5 to 20 minutes. 

15. Cold sitz bath 50-80 60 5 to 15 minutes. 

16. Half bath 50-80 65 2 to 5 minutes. 

17. Cold plunge 50-70 60 Instantaneous. 

18. Hot full bath 100-115 104 2 to 10 minutes. 



£, 



106 PRACTICAL HYDROTHERAPY. 

Bath. Temperature, Average Tem- Duration of Bath. 

Degrees F. perature. 

19. Cold full bath 50-70 60 3 to 10 minutes. 

20. Warm full bath 96-100 98 5 to 30 minutes. 

21. Neutral full bath 94-96 95 20 to 60 minutes. 

22. Brand bath 60-70 65 10 to 15 minutes. 

23. Hot rain bath 104-120 105 Vi to 1 minute. 

24. Cold rain bath 50-70 60 5 to 20 seconds. 

25. Hot fan douche 104-120 115 Yz to 1 minute. 

26. Cold fan douche 50-70 60 10 to 20 seconds. 

27. Hot jet douche 104-120 115 Yi to 1 minute. 

28. Cold jet douche 50-70 60 10 to 20 seconds. 

29. Hot air bath 110-180 160 5 to 20 minutes. 

30. Body superheated dry 

hot air treatment 200-400 275 20 to 60 minutes. 

31. Local hot air bath 200-400 300 20 to 60 minutes. 

32. Turkish bath 150-200 180 10 to 20 minutes. 

33. Russian bath 110-130 120 10 to 15 minutes. 



CHAPTER VIII. 

EQUIPMENT OF HYDROTHERAPEUTIC INSTITUTIONS 
AND SANATORIA. 

The acme of hydrotherapeutic accuracy, the best and most per- 
manent results in chronic diseases, are obtained from treatment in 
institutions and sanatoria, where every facility is at hand for the 
refinement of technique. I have obtained results with a few sheets, 
pails of water and mediocre intelligence in a way that bespeaks highly 
the effects of water, even under most disadvantageous conditions, 
when used in acute diseases and acute manifestations of chronic 
troubles. The most efficient method is the douche, in its various forms 
and modifications, because of its powerful thermic and percutient 
effects. This procedure is preferred in sanatoria and institutions more 
than any other method, because of its efficiency and the shorter time 
required for treatment. The general practitioner of medicine should 
not, however, be deterred from using hydriatic procedures in acute 
febrile and other manifestations of disease, for in this field some most 
startling and remarkable results are obtained. It is the chronic cases, 
those who are sick all over, whose nutrition is bad, who need the gen- 
eral control that sanatoria exercise, that the practitioner should send 
away, for in these cases it is necessary that the patient should give 
himself up entirely to health-getting in order that he may secure 
good results. 

Hydrotherapeutic apparatus is, of necessity, bulky and expensive, 
and its erection and use entail a cost by no means inconsiderable. 
The arrangement and plan of such an institution will depend largely 
upon the character of the building to be used for the purpose. The 
best place to locate the rooms is in the basement; in case of a leak 
no injury would result to contents located upon lower floors. For 
the sake of clearness, two drawings are herewith appended ; one where 
a large oblong, the other where a narrow and long space is to be used. 
This latter arrangement is particularly applicable to large cities, where 
the houses are more or less narrow and the buildings of some length. 

Before arranging his institution the hydriatist should satisfy him- 
self on several points in order to insure the successful use of the 
apparatus he proposes to install. An abundant supply of water is 
necessary. It goes without saying that the water to be preferred should 
be soft and contain as little mineral as possible. Clear water, from 
esthetic and other standpoints, should be used, although this cannot 
(107) 



108 PRACTICAL HYDROTHERAPY. 

always be obtained. Mineral waters offer absolutely no advantage 
whatsoever in the practical applications of hydrotherapy. The next 
essential is sufficient volume and pressure within the building. With- 
out sufficient pressure the various forms of the douche will fail of 
their effect and disappointment result. I am constrained to believe 
that thirty — better still, forty — pounds should be the minimum. In 
my sanatorium I have a pressure of 100 to 125 pounds, and at times 
need this full pressure. In order to obtain sufficient volume and 
pressure, the main supply pipe should, in my opinion, be of a mini- 
mum diameter of four inches from main to boiler or heating appa- 
ratus ; from this point to the douche apparatus the pipe should be of 
a diameter not less than two inches, and the douche apparatus pipes 
of not less than one inch in diameter. These dimensions are, as a 
rule, difficult to obtain from water companies unless intelligent ex- 
planation is made of the essential need of such a supply for treat- 
ment. Attention should be given to the question of ventilation and 
heating. Where the institution is located in the basement, ample 
windows with areas permit of a free circulation of air in summer 
and a proper ventilation in winter. This will also give light, al- 
though in the majority of instances light will, even in the day time, 
be obtained by artificial means. Care must be exercised to avoid 
draughts, and to this end those rooms in which the temperature is 
raised should be provided with spring doors completely closing the 
openings. 1 am of the opinion that the douche-room and other treat- 
ment-rooms should have a temperature of from 75° to 80° F. 

One of the esesntial necessities of such an institution is an unlim- 
ited supply of hot water during all the months of the year, and of 
cold water during the summer months, to secure temperatures be- 
tween 50° and 60° F. In summer time water from a deep well is 
of a sufficiently cold temperature for all practical purposes. 

This brings us to practical consideration of the floor plan of such 
an institution. By referring to the diagram the writer believes the 
reader will find there incorporated certain features that are of de- 
cided advantage. Note should be taken of the fact that the floor plan 
calls for two separate halls, an outer and an inner one. It is obvious 
from this plan that the servants whose duty it is to attend to the 
boiler for heating the water can enter the boiler room without coming 
in contact with those who are taking treatment. The various treat- 
ment-rooms open upon the inner hall, and are provided with doors 
that completely close the opening. I deem it of importance that the 
cooling- or rest-room should be at the extreme end of the floor plan. 
This room should be moderately lighted, and furnished with a number 
of cots, or, better, couches, upon which patients may recline. Ex- 
perience has taught me that a leather couch, properly protected, is 
the best for this purpose. Adjoining the rest-room is the dressing- 



o 

C 
H 

n 

r 
r 



.S, 



DOUCHES. ENEHRS 
PRCKS 




DOUCHE ROOH 



00 

J 

SITZ 

TUBS 



INCHBDESCEMT 
QELQCTRiC 
LIGHT QflTI 

.N 



ELECTRIC LIGHT 
DR^3 HOT RIR ROO 



I THBLE 

VYBLL. 

APPARATUS 



HND r—C\ 

on ' — y 



3 O 
H OT 


D 3 

HI R 



V V 
DRESSING ROOM 



\, 



r 



D L~ 



D LZZ> 



REST ROOM 



D I ) 



D 



. t , a_h-J 



Plate 40— Author's Plan. 




W4RMING CLOSET' 



Plate 40a — Diagram of Hydriatic Room (Mott). 



EQUIPMENT OF SANATORIA. 109 

room. This room should, in my opinion be painted a white color, 
and the individual dressing-rooms or stalls furnished with perma- 
nent latticed swinging doors. The lower edge of the partitions is 
about nine inches from the floor, and rest upon nickel-plated brass 
holders. Each room is furnished with from eight to ten porcelain 
hooks upon which clothing may be hung; also a chair for the pa- 
tient's comfort. It is hardly necessary to state that the reason for 
the raising of the partition nine inches from the floor and the painting 
of the room a white color is to give more and better light in each 
compartment. Adjoining the dressing-room is the general treatment- 
room, which should be furnished in marble, and in which there should 
be hot air, superheated hot air, vapor and incandescent electric light 
baths. The author's experience has been so favorable with the incan- 
descent light bath that he has almost entirely dispensed with the use 
of the ordinary hot-air cabi.net in this room. We would also have an 
incandescent electric light cabinet, a special arc cabinet bath and a 
body and joint apparatus for the application of superheated hot air. 
For the construction and arrangement of these cabinets the reader is 
referred to the previous chapter, in which they have been fully dealt 
with. It will be noticed that from this room a door opens into the 
"douche-room." This room must be especially constructed. In my 
sanatorium there are brick walls on each side laid in cement and cov- 
ered with white porcelain tile closely and carefully laid on. The 
floor is laid in rough concrete and abruptly drained to the center. 
The room is twelve feet broad by twenty feet long in the clear. Along 
one wall is to be found a foot and two sitz bath-tubs, mounted on 
marble platforms. These tubs are so arranged that the water from them 
drains upon a concrete floor, and not over the marble base. Adjoin- 
ing these is a large porcelain bath-tub, seven feet long, placed upon 
the concrete floor. On the rear wall a shower, triangle and circular 
rain-bath are located. The room is equipped with the author's wall 
apparatus and Baruch's douche table. This wall apparatus and table 
are connected with the circular rain, triangle, fan, jet and other 
douches. It is impractical to operate the foot, sitz and full bath from 
the douche table, so the author has discontinued this method and 
supplied each of these with a separate hot and cold water supply, 
using one-inch brass nickel-plated piping and large one-inch faucets 
for the purpose. As this apparatus and the method of its employment 
will be fully described in a later chapter, no comment will be here 
made. The rear room should be supplied with several tables or 
couches for packs, fomentations, compresses and enemas. At the end 
of the hall a toilet-room is provided. 

All of the rooms are furnished with concrete floors. In the cool- 
ing or rest-room a rug should be spread between the couches. The 
writer has, after numerous trials, found that the ordinary rubber 



110 PRACTICAL HYDROTHERAPY. 

carpet is by far the most satisfactory covering for the floor. It does 
not become cold in winter nor hot in summer, and with the moisture 
present rarely, if ever, rots. The concrete floor of all the rooms, ex- 
cept the douche-room, should be of the smoothest kind. The douche- 
room is furnished with a slatted floor so arranged as to be perfectly 
level. This requires the sleeper upon which the slats rest to be 
beveled so as to fit the sloping floor of this room. The slatted floor 
should be constructed in five or six sections, so arranged as to enable 
them to be easily lifted for the purpose of cleansing the floor be- 
neath. They should be made to fit snugly around the douche table, 
the marble base of the foot and full bath-tub, triangle and circular 
rain bath. The timber used must be the very best of kiln-dried cedar, 
put together with brass screws, free from all knots, and the edges of 
the slats rounded with a plane. The entrance from the general treat- 
ment-room to the douche-room should either be on a level with the 
top of the slatted floor or furnished with a slanting entrance to pre- 
vent patients stumping their toes. The entire place must be lighted by 
overhead electric lights, manipulated by easily accessible switches. 

The rapid resume of a patient's treatment would be the entrance 
from the outer hall into the inner hall and dressing-room, where, 
after disrobing, with a sheet thrown around him, he enters, at the re- 
quest of the attendant, the general treatment-room, receives a pre- 
liminary aplication of the incandescent, arc or hot-air bath. Following 
this he enters the douche-room, and, after receiving the hydriatic 
measures prescribed, and reacting properly, he is then dried and re- 
tires along the inner hall to the cooling or rest-room, from which he 
shortly emerges, resumes his street attire, and departs. 

It is necessary to have an ample supply of towels, preferably of 
the rough Turkish variety ; linen and Turkish sheets, Turkish bath 
robes, stockinettes and glovelets for use in the superheated dry hot-air 
apparatus ; several rough linen sheets, a dozen or two of fine linen 
sheets, some large soft woolen blankets, a pair of double blankets for 
the wet sheet pack, fomentation cloths made of thin blanket, cheese 
cloth for compresses, ice helmet, hot-water bottles, etc. The treat- 
ment-rooms should be supplied with a large and commodious closet, 
with tight fitting door and Yale lock. In this closet all the linen, 
blankets, and various articles mentioned above, should be kept, and 
if the door fits accurately the moisture in the air will not penetrate 
and make the articles damp or mildewed. There should be sufficient 
room in which to place under lock and key bath-robes, bath-caps, 
shoes, slippers, etc., belonging to individual patients. This may seem 
a small detail, but the careful enforcement of the rule of keeping 
things locked up will prevent many petty quarrels between patients, 
attendants and others, to say nothing of preventing stealing. The 
douche-room must be supplied with a large nickel-plated brass soap- 



I 

H 
o 



> 






a 



o 



H 
o 

R- 





Plate 43— Bath Room Accessories; Pitcher; Salt Jar; Thermometer; Fibre 
Bucket ; Bath Room Floor Slats. 



EQUIPMENT OF SANATORIA. Ill 

stand, with "Ivory" soap for those who desire to use same; a large 
two-gallon pitcher, preferably of granite ware; large pail and a large 
jar filled with salt of medium coarseness. It should be borne in mind 
that perfect cleanliness is one of the prerequisites for the preserva- 
tion and usefulness of all apparatus enumerated. The room should 
be cleaned thoroughly daily, the incandescent globes in the incandes- 
cent electric light bath carefully wiped free of dust and specks, the 
nickel-plated trimmings in the douche-room rubbed, and such other 
housewifely cleanliness maintained as common sense would dictate. 

It is a small but practical point to be borne in mind that the nickel- 
plating and bright appearance of all piping of the various pieces of 
apparatus will be preserved and maintained if the attendant will be 
sure to allow very hot water to run through the apparatus just before 
leaving the treatment-rooms. 

In speaking of the electric light bath, it was stated that the 
attendant must never throw on the main switch while the smaller or 
knife-blade switches governing the various rows of lights are in con- 
tact, as the fuse will be blown. This can be prevented by having the 
large switch next the ceiling out of the reach of the attendant, thus 
preventing mischief of this kind. To run an incandescent electric 
light bath of even moderate size is an item of considerable expense, 
and attendants should be instructed to never turn on the lights until 
the patient is in the cabinet, and to ahvays turn off the lights before 
the patient leaves the cabinet. This is also true of the arc light, and 
in less measure of the superheated dry hot-air apparatus. 

A large basket should be furnished in the dressing-rooms in which 
the patient may toss the wet towels that have been used. Most 
institutions of this kind and sanatoria find many of their towels ruined 
by that frailty of human nature which leads patients to polish their 
boots and shoes with other people's towels. For this and for other 
good and excellent sanitary reasons all towels must be thoroughly 
washed, boiled or sterilized and then dried. In my sanatorium, for 
the purpose of drying, an artificially heated drier is used. Small soft 
towels are furnished for facial use, although in many instances the 
rougher or crash towel is to be preferred. Each dressing-room, or, 
what is more preferable, each patient, should be furnished with, or 
furnish himself, a soft linen sheet in which to enwrap the body 
during his passage from the dressing-rooms to treatment and vice 
versa. By wrapping the patient in a sheet too rapid evaporation is 
prevented, and he is not chilled by passing to or from dressing- and 
treatment-rooms. By just such little details and precautions colds 
and discomforts are prevented and success secured. There are a 
number of cases whose reactionary power is so great that they might 
dispense with the use of a sheet, but from esthetic as well as hygienic 
reasons it is required. Those persons who chill very easily should 



112 PRACTICAL HYDROTHERAPY. 

wear sandals, shoes or slippers to and from the bath treatment-rooms. 
There is no question in these cases but what the difference in tempera- 
ture at the floor and higher in the room is sufficient to produce this 
condition. The author would suggest the heelless sandal so much in 
use in German and Austrian bathing establishments. 

Upon leaving the treatment-rooms at the end of the day the 
attendant gathers up and removes all wet towels and sheets ; opens the 
windows, especially in summer, to secure ample ventilation, and leaves 
everything in tidy condition. If this becomes a fixed habit the musty 
odor common in some hydriatic institutions will be obviated. 

It is necessary to have a scale in all hydriatic institutions, the 
pivot and other portions of which should be of brass so that it will 
not rust in the humid atmosphere. As I have stated before, it is 
necessary to watch the nutritional changes taking place in patients, by 
the scale, for any marked change in weight should at once challenge 
the attention of the hydriatic specialist and lead him to modify his 
treatment according to the aim and purpose to be attained. 

There is nothing so valuable to a physician as an intelligent, careful 
and sympathetic attendant in the bath-room, one who thoroughly 
appreciates and understands the prescription, and who can intelli- 
gently vary minor details to the comfort and satisfaction of the 
patients. Nurses and attendants soon learn to carefully note the 
condition of the patient entering the treatment-room. The ability to 
tactfully induce patients to take a bath who are unaccustomed to cold 
water is attained only by considerable experience. It is my rule to 
invariably start with graduated applications both with regard to 
thermic and mechanical impressions, and in this way much distress 
is prevented. By gradually accustoming the skin surface to reaction 
and to the mechanical impressions produced by the more vigorous 
applications to the external surface, the most sensitive and delicate 
can be brought to bear very low temperatures and strong mechanical 
impressions. Here again I repeat that the essential necessity of 
success not only depends upon the careful and thorough work of the 
attendant, but upon his securing prompt satisfactory reaction, together 
with all the exhilaration and stimulation that follow. Nurses who 
have had long training in hydriatic work can promptly tell, by the 
touch of the hand, something of the reactive capacity of patients. 
The attendant should insist, where the patient is strong enough, that 
he rub himself, and thus aid in bringing about reaction. 

Be careful to see that the head is kept cool during the application 
of any heating procedure, and even during the bath itself. Wet the 
hair thoroughly and keep a cold towel or turban upon the head during 
the application. Some men, and nearly all women, refuse to have the 
hair made thoroughly wet, owing to the difficulty and fatigue of drying 
the scalp after a thorough wetting of the hair. This can be obviated 






Plate 44— Ice Cap or Helmet; Steam Kettle. 



EQUIPMENT OF SANATORIA. H3 

by the use of a cap made of rubber or oil silk, ice helmet, or by bathing 
the face in cold water just before and keeping a cold towel around the 
neck during the hot application. The author is very much opposed 
to a hubbub in the bath-rooms. Hilarity, singing, whistling, noisy 
talking, loud laughter and joking are decidedly out of place. Quiet 
should be maintained and patients encouraged not to converse with 
each other or with the attendant while taking treatment. It has been 
my observation that in this way better attention is secured and more 
care taken with the patient. 



h 



CHAPTER IX. 
THE TECHNIQUE OF HYDROTHERAPY. 

As it is in all branches of the healing art, hydrotherapy possesses 
its proper technique. As a surgical operation is incomplete or a 
failure unless the proper method is pursued, so in hydriatics those 
results that can and should be obtained are lost unless care and atten- 
tion are given to proper detail. Most hydriatists in their treatises 
upon this branch are prone to magnify and refine each process until 
the student and practitioner are lost in a maze of minutiae, become 
disheartened and give up the study of a valuable measure, possibly 
the best single weapon of his therapeutic armamentarium. My 
endeavor has been to simplify as much as possible, to group together 
measures that have similar physiological and therapeutic action, or 
that employ similar apparatus and technique, thus doing away with 
needless burdens upon the time and memory of the active man in the 
field. The time that has to be consumed by the busy general practi- 
tioner over such works leads them, as well as hydriatics, to be laid 
aside for methods more easily mastered. 

Having learned the physiological portion of hydrotherapy, we are 
prepared to understand that the technique may be grouped under six 
heads, dependent upon the methods used as to whether we desire 
to obtain — 

A. Distinctly local effects. 

B. General effects. 

C. Purely thermic effects. 

D. Thermic effects supplemented by mechanical action. 

E. Employing the same apparatus. 

F. Having the same physiological action. 

In the actual treatment of a case the power to respond to these 
methods must be carefully studied, or, as Winternitz puts it, "the 
degree of stimulation" estimated ; in fact, here as elsewhere the per- 
sonal equation and therapeutic need cannot be lost sight of for a 
moment. The "measure of stimulation" is controlled by means of 
four elements, viz. : 

1. Extent of application. 

2. Temperature. 

3. Duration. 

4. Mechanical effects. 

(114) 



I 

in 



H 
o 
3 



Cd 




THE TECHNIQUE OF HYDROTHERAPY. 



115 



At the present time we are unable to classify from a physiological 
point of view, and for that reason the author offers the following 
"Clinical Order," it being an advance from the simple to the complex : 

Sp °^ e { CoM 

Alternate hot and cold sponge to the spine. 

Dripping sheet. 

Fomentation. 

Compresses. 

Half pack, dry. 

Full pack, dry. 

Half pack, wet. 

Full pack, wet. 

Hot foot bath. 
Cold foot bath. 



Foot bath 



Sitz bath ( J?ot "Sitz tath. 
i-^_ [_ Cold sitz bath. 

Half bath>~- 



— i 



°*^- t.(«*AV^ 



Full bath 



" Very hot full bath. 
Hot' full bath. 
Warm full bath. 
Cleansing full bath. 
' Continuous full bath. 
Neutral full bath. 
Effervescent full or Xauheim bath. 
Cold full bath. 
I Cold plunge. 
Surf bathing. 
Swimming bath. 
Mineral baths. 

Affusions. 
Showers. 
Sprays. 
„ Jet douches. 



Douches 



The Sponge or Towel Bath; Ablution. 

This simple and satisfactory method is universally applicable, and 
may be employed in the humblest of surroundings. It may be used as 
an antipyretic or as an introduction in chronic cases to the more 
vigorous measures. The sponge is usually given to febrile patients 
in bed. Two basins, containing water at the proper temperature, one 
of 50° F., the other 70° to 60° F. ; a slop jar, two crash rags and 
several crash towels without fringe is the simple paraphernalia re- 
quired. The nurse, having arranged the basins, jars, rags and towels 
handy, slips off the night dress and has the patient recline upon the 
right side (edge) of the bed (in right-handed nurses) facing the 



116 PRACTICAL HYDROTHERAPY. 

nurse. The rag is now dipped in the basin of water at 50° F. and the 
face and neck sponged. The surplus water is squeezed into the slop- 
jar, the rag re-wet and placed upon the patient's forehead. The 
patient's left arm, then the right, the left and then the right leg, are 
successively exposed and sponged with the crash rag, containing all 
the water it will hold short of dripping, The patient then turns over, 
lying on the belly, and the back is sponged from occiput to coccyx and 
over the hips ; then turns upon the back, and the chest and abdomen 
are sponged. If longer time is employed allow towel, after sponging, 
to remain on back, chest and abdomen three minutes each. As we 
have previously said, the towel or compress may remain on the 
abdomen for an hour after the sponge. Very feeble cases, who 
are febrile, whose circulation and innervation are bad, who are easily 
exhausted (asthenic), should have each member dried as the applica- 
tion is made, and the towel or compress avoided. After the bath 
they receive their nourishment, and if they have not reacted a hot- 
water bottle must be put to their feet. If strong and vigorous 
(sthenic), do not dry and use the towel or compress. Where this 
measure is employed systematically during the course of typhoid, 
bathe, feed and medicate at the one time so that the patient and nurse 
will have intervals of rest. Cold water drinking between times is a 
useful adjunct. 

It is a good plan to start with high temperatures, giving the first 
bath at 75° F., reducing the temperature of each succeeding sponge 
five degrees to 60° or 50° F., as deemed wise. Always use cold (50°) 
or very cold water to bathe the face and neck ; re-wet this compress as 
soon as it gets warm. The water in the rag should be squeezed out 
into the slop-jar and re-wet from the basin to avoid warming the 
water. 

The sponge must be varied to meet certain indications. If the 
case is febrile, vigorous, with good innervation and considerable anti- 
pyretic and stimulating effects are desired, the arms and legs should 
be left wet, in order that evaporation may enhance the anti-febrile 
action of cold water. When the back, chest and abdomen are 
reached they should first be sponged, then wet thoroughly one of the 
crash towels and place upon the entire back, chest and abdomen, or 
each successively, and over which friction is to be applied. It may be 
wet and re-wet'from the basin without removal. Friction, as we have 
seen, ove-comes the superficial contraction, dilates the blood-vessels, 
and by reflex action, as well as by heat abstraction, acts upon the 
thermogenic and vasomotor centers in the medulla and cord, limiting 
heat formation and increasing heat elimination. As we cannot secure 
friction from a sponge, it should never be employed. In typhoid 
( mild cases, temperature not above 102.5° F. ) this method, repeated, 
will give excellent results, and may be employed during the entire 




n 

o 



o 

3 




THE TECHNIQUE OF HYDROTHERAPY 117 

course of the disease. In this infectious disease the towel may be 
wet and re-wet several times during the course of the time it re- 
mains on the abdomen. The time required for the entire sponge 
is usually thirty to forty minutes — arms four minutes each, legs four 
minutes each, back and chest four minutes each, abdomen six min- 
utes. Always keep a cold compress or ice cap on the head as this will 
prevent a rush of blood to the head, or rctrostasis, besides making 
the patient more comfortable. Be sure to always make sufficient 
pressure with the rag to create friction. When completed, slip on the 
night dress, and in febrile cases cover lightly (with sheet). 

The physiological action is that of cold applied to the external sur- 
face, together with the supplemental influence of friction. The 
peripheral circulation becomes larger through the reflex action of 
the friction, thus offering a larger surface of blood to the thermic 
action of the cold. Reflexly, the heart is slowed, the pulse becomes 
fuller, and the cooled blood current, setting inward, reaches and 
arouses the nerve centers to throw off the toxic lethargy. The res- 
piration is freer, better oxygenation and elimination take place from 
this and all other excretory organs. The nervous system is toned, 
aroused and refreshed; the patient is stimulated, and, as we have 
before noted, temperature reduced. It is now much used in typhoid, 
although the valuable effect of the compress with friction is rarely 
employed. 

The author remembers the grateful toning and refreshing influ- 
ence of the cold sponge at 50° when, several years ago, he had the 
one and only febrile attack of his life. The intense neural and sys- 
temic relief given more than compensates for the temporary discom- 
fort of its application. 

As an introductory, in chronic diseases and ambulatory cases, to 
more active measures, the author uses it as follows : A heating meas- 
ure is first employed— pack, hot air, electric light bath— after which 
the patient steps into a foot-tub of very hot water, and is rapidly 
sponged— face, neck, arms, trunk, legs. There should be considerable 
friction used, and reaction afterward secured by means of good rub- 
bing with a warm crash towel. This measure I have found of signal 
benefit as a home remedy in cases that cannot come for institutional 
treatment. It is astounding what an influence this simple bath will 
exert upon anemia and chlorosis, in neurasthenics, the pre-tubercu- 
lous and others. These cases can apply the treatment themselves, it 
being generally used on arising in the morning, owing to the fact that 
the person has accumulated heat upon the surface during the stay 

in bed. 

Hot sponging may be employed in fevers, but is now rarely used. 
The sponge should be very brief with water at 130° to 140°. It is 
sometimes useful when applied to the spine in functional nervous dis- 



118 PRACTICAL HYDROTHERAPY. 

eases, neuralgia, etc., but the author prefers the alternate sponge for 
this purpose. Alkalies, usually soda, may be added and used in urti- 
caria, pruritus, etc. Friction is not needed. 

The alternating hot and cold sponge to the spine is a useful meas- 
ure that will give relief in certain conditions. It is best performed 
by using a cloth wrung out of the very hottest water that can be 
borne (140° to 160° F.), applying it up and down the spine for ten 
to thirty seconds, followed by a sponge or rag dipped in very cold 
water (40° to 50° F.), or a block of ice wrapped in a soft towel, for 
three to ten seconds. These alternations should be kept up three to 
five minutes or longer, if agreeable to the patient. The alternate 
sponging of the spine has. in my hands, been chiefly used for insomnia, 
although it aids in overcoming the unpleasant spinal symptoms of 
neurasthenia. Most patients state that it has a decidedly reviving 
effect upon the system. It can be used in all forms of irritation, 
whether located in the spine or not, in headaches, intercostal neu- 
ralgia and general nervousness. It has a decided influence upon res- 
piration and heart action, and for this reason is of value in those 
troubles accompanied by the sudden failure of action of either of 
these organs. For the temporary amelioration of the pain and dis- 
comfort at the nape of the neck, often complained of by women, 
it will be found a resource of some value. In bruises, injuries to 
joints, sprains, inflammations of muscles, the pains of trauma, trau- 
matic arthritis, etc., relief from suffering and restoration of function 
often follow its use. 

The Dripping Sheet or Sheet-Bath. 

This is a simple, satisfactory and ingenious method of applying 
water to the surface of the patient who, for certain reasons, is unable 
to stand other measures, is bedridden or the subject of acute disease. 
In applying the sheet-bath the paraphernalia used are a linen sheet, 
preferably coarse, about three yeards long and two yards wide; a 
pail in which to wet the sheet, a foot-tub for hot water, a dry sheet 
and some Turkish towels. The nurse, having previously gathered 
the sheet together by one edge of the long measure, places same in 
the pail of water at the temperature indicated, ranging from 50° to 
70° F., and partially wrings the water out. The patient, having had 
his face and head, or in women the neck, cooled and protected by a 
cold towel, turban or ice-cap, steps into the foot-tub containing hot 
water of sufficient depth to cover well the ankles. If the water in 
the foot-tub is sufficiently hot, much of the disagreeable sensation 
of cold will be obviated. The patient now removes the night dress 
or throws off the dry sheet with which he is covered, and the wet 
sheet is wrapped around the body in the following manner : Holding 
the long measure of the sheet in the right hand, the nurse seizes the 




Plate 47— Dripping Sheet— Ready. 




Plate 48— Dripping Sheet— First Stage. 




Plate 49 — Dripping Sheet — Second Stage. 




Plate SO — Dripping Sheet — Completed. 



THE TECHNIQUE OF HYDROTHERAPY. 1}9 

upper left hand corner with his left hand, and steps in front of the 
patient. The patient holds up both arms while the nurse places the 
upper left hand corner of the sheet under the right arm, far enough 
to reach the back ; the patient then lowers the right arm, holding the 
sheet in place; the nurse rapidly passes the sheet across the front of 
the body, beneath the left arm, which is immediately lowered to hold 
the sheet in place. The sheet is then carried across the back, brought 
up over the right arm and shoulder, across the chest, and over the 
left arm and shoulder. It is then folded and tucked into the upper 
edge around the neck. Where the nurse is quick this operation does 
not consume more than five to ten seconds, and when promptly per- 
formed does away with a great deal of the discomfort of a slowly 
applied cold body. The lower ends are now tucked between the legs. 
The sheet being in position, the nurse begins to rub vigorously with 
both hands, using good sweeping strokes, covering the whole surface 
as quickly as possible, rubbing simultaneously first the chest and back, 
then the back and abdomen and then the extremities. The rubbing 
should be continued from one to three minutes, or until the sheet is 
thoroughly warm. It should be borne in mind that the object aimed 
at is not rubbing the patient with the sheet, but the application of 
friction over the sheet. Rapidity of movement in placing the sheet 
in position and the quick application of friction are essential, for the 
object is not to abstract heat, but to produce tonic reaction and a de- 
cided cutaneous hyperemia. When the sheet has become well warmed 
it is quickly dropped, the patient covered with a dry sheet and rubbed 
thoroughly dry with Turkish towels, after which the bed. If reac- 
tion has been prompt, no other application is necessary; if the patient 
feels chilly, dry friction with the hand will complete the reaction. It 
should be noted that the patient must be protected from chilling upon 
removal of the sheet. 

This treatment is simple and flexible. The different amounts of 
water it contains, variation in temperature, the amount and vigor of 
the rubbing, or the addition of percussion or slapping, will enhance 
its physiological action. The temperature of the water generally used 
ranges from 70° to 50° F., but the aim is to reach the colder degree 
as rapidly as possible. It is the author's custom in weak and bed- 
ridden cases to commence with mild temperatures of very short dura- 
tion, and gradually decrease the temperature and increase the dura- 
tion until the maximum effects are obtained. Patients that are 
strangers to the hydrotherapeutic reaction will complain at first, but 
later along will not mind even a temperature of 60° or 50° F. Where 
the patient is in condition, however, to stand the primary shock, it 
is my custom to commence with 70° to 65° F., as we obtain a better 
reaction. The temperatures of the sheet-bath can be materially low- 
ered where a preliminary heating process has been used. For this 



120 PRACTICAL HYDROTHERAPY. 

reason it is best applied to bedridden, sensitive or debilitated patients 
early in the morning, when they have the accumulated heat of the 

.night upon the skin surface. 

| Physiological Action of the Dripping Sheet. — The dripping sheet 
or sheet-bath is a thermic and mechanical irritant, causing deep gasp- 
ing respirations, rigor or shivering, but this shock of the first impact 
of cold upon the surface gives way to a stimulating and refreshing 
action upon the nervous system. There is a general sensation of 
warmth and glow in the skin. The peripheral blood-vessels at first 
contract and drive the blood from the cutaneous surface, but with 
the reaction that takes place under friction the blood-vessels dilate 
and blood comes to the surface. The pulse is slowed, heart action 
becomes more full and energetic, and blood pressure is raised. By 
this means the work of the heart is diminished. This cutaneous circu- 
latory reaction is pronounced and lasting, and accompanying it are 
all the phenomena noticed under "reaction." If a tonic effect is aimed 
at, reaction must be prompt and vigorous; if antipyretic, it must be 
slowly obtained. The depth of the respirations are increased, more 
prolonged, and exchange of pulmonary gases favored. Muscular ac- 
tivity is increased, strength engendered, well-being induced, all oxida- 
tive and assimilative functions stimulated, and, secondarily, appetite 
and digestion improve. There is a uniform fall of the rectal tempera- 
ture, though this is temporary ; the axillary readings may remain the 
same or become elevated. The excellent results obtained from the 
dripping sheet make it a procedure valuable beyond computation to 
those practicing in rural districts. It is to be regretted that the gen- 
eral practitioner is, as a rule, prejudiced against hydriatc procedures, 
and fears the bugbear of cold water. 

Therapeutics of the Dripping Sheet. — The sheet-bath is an excel- 
lent measure for those who are feeble, bedridden, or undergoing the 
rest cure, relieving, as it does, the various circulatory disorders asso- 
ciated with these conditions. Owing to the lack of exercise, it is 
necessary to have some measure by means of which the slow reac- 
tions and more or less chronic congestion of the viscera can be re- 
lieved. In those digestive states in which we have to deal with dimin- 
ished secretion, lack of muscular capacity, with relaxed or prolapsed 
abdominal viscera, the sheet-bath offers a valuable and potent rem- 
edy. The author has found it of especial benefit in the Weir Mitchell 
rest cure treatment, in nervousness, excitability, insomnia, neuras- 
thenia, etc. As an adjunct to the administration of iron in chlorosis 
and anemia, especially in that form that is prevalent in young girls, 
accompanied with digestive disorders, the dripping sheet has proved 
itself to be a most potent factor in the therapeutics of these affections. 
In the management of diarrhea and dysentery the author can speak 
from long experience of the value of this measure, used in conjunc- 




Plate 51 — The Fomentation — Ready. 




Plate 52 — The Fomentation — Pouring the Boiling Water. 



THE TECHNIQUE OF HYDROTHERAPY. 121 

tion with the sitz bath and friction. There are few contraindications, 
the principal obstacles being skin eruptions, neuritis and neuralgia. 

The Fomentation. 

This application is usually called the "hot fomentation," but, as 
fomentations are never cold, the addition of the adjective is super- 
fluous. The fomentation is a most valuable procedure. It is applied 
preferably by means of a piece of old blanket about a foot and a half 
square, which, after being saturated with boiling zvater, must be thor- 
oughly wrung out by means of a wringer. The simplest manner of 
constructing this wringer is to use a piece of ducking of sufficient 
size, to the extremities of which two strong sticks, about two feet 
in length, have been secured by tapes, a hem or stitching, so that 
their ends project sufficiently on each side that the nurse may com- 
fortably grasp the ends without coming in contact with the ducking. 
Its technique is as follows : The patient lies upon the bed or couch, and 
the part to be treated is exposed and enveloped in a blanket pack 
covering a considerably larger area than the fomentation, the ends 
of the blanket being long enough to go well over one another. The 
nurse heats a large pot of water to the boiling point and then pre- 
pares the wringer, after which the skin surface is thoroughly anointed 
with an oleate — vaseline or cocoa butter. The nurse places the wringer 
over a bucket or deep basin (see cut), and on it the piece of blanket, 
a Turkish towel, flannel or woolen cloth, or any other material (the 
blanket is best), and then pours over the piece of blanket boiling water 
until it is thoroughly saturated. It is now lifted out of the basin by 
means of the wringer, allowed to drain for a couple of seconds, and 
the sticks twisted in opposite directions (see cut) so that every pos- 
sible drop of water is squeezed out. This is an important element 
of the technique, for if any water remains we are liable to scald the 
patient. Little fear of a burn need be entertained if the part has been 
well rubbed with the oleate and all the hot water has been carefully 
squeezed from the piece of blanket. So essential is this that it should 
be constantly impressed upon nurses. The nurse takes the twisted 
wringer containing the hot moist piece of blanket, lays it beside the 
patient, opens the blanket, then unwraps the wringer, slides out the 
fomentation upon the affected part and removes the wringer. It 
must be quickly adjusted to the part, the blanket closed, and all air 
excluded by drawing the blanket pack tightly over the fomentation, 
and especially close at the ends. The patient will likely complain of 
the intense heat, and squirm some, but must be encouraged to bear 
it, as this will disappear as soon as the tissues relax. If the heat can- 
not be endured, the nurse may "ease" matters a little by lifting the 
fomentation from the surface for a few seconds, without greatly loos- 
ening the blanket pack, and again dropping it in place and retightening 



122 PRACTICAL HYDROTHERAPY. 

the pack. The fomentation may remain in place for five to ten min- 
utes, and may be immediately repeated, or again as soon as the phy- 
sician deems wise. If it is immediately repeated the parts must be 
kept covered by the blanket pack, and the process gone through with 
as little loss of time as possible. Two pieces of blanket will be found 
useful on such an occasion, the nurse preparing the second one while 
the other is in place, being thus enabled to make the exchange with 
great rapidity, a feature much to be desired. The beneficial effect 
of the fomentation can be decidedly enhanced by terminating the 
treatment with a brief cold application not to exceed a minute. The 
part is then dried, rubbed briefly with the dry hand and protected 
from the air. 

Physiological Action of the Fomentation. — The immediate effect 
produced by the contact of this very hot body is that of pain, accom- 
panied by a blanching of the tissue, due to contraction of the blood- 
vessel walls. The confined heat, acting upon the sensory nerve termi- 
nations and penetrating the tissue by conduction, causes almost im- 
mediately a dilatation of the blood-vessels of the skin and contiguous 
tissues, through paralysis of the constrictors and relaxation of the 
contracted muscular tissue in the blood-vessel walls themselves. Pri- 
marily a local revulsive, excitant and stimulant of functional activity, 
it becomes secondarily a sedative, relaxant and analgesant of no mean 
power. The high temperature stimulates local leucocytosis, is anti- 
bacterial, relieving inflammation. Anatomically related areas may be 
influenced by its use. It may be employed as a derivative to relieve 
congestion, pain and inflammation. It is a stimulant of tissue metabo- 
lism, increasing the functional activity of a part through the aug- 
mented circulation and nerve action. Where long continued, the part, 
upon its removal, follows the law of heat, becomes atonic, its processes 
and vitality lowered. This may be obviated by a very brief appli- 
cation of cold. The best results are obtained when the fomentation 
causes slight pain when first brought in contact with the skin. Its 
temperature should range from 140° to 160° F 

Therapeutics of the Fomentation. — It is a simple method that 
has a wide field of application, and in skilled hands its action is often 
magical. In all those states, acute or chronic, which are attended by 
congestion, inflammation and pain, we find the fomentation indicated. 
Where we wish to increase tissue change, leucocytosis, absorb swell- 
ings and exudates, we may expect most satisfactory results, especially 
when it is followed by the cold, cool or stimulating compress. In 
spasmodic muscular states, tremor, cramps, colics accompanied by 
cramps ; in gastritis, enteritis, hepatitis, cystitis, peritonitis, all inflam- 
mations of the pelvic viscera, external organs of generation ; in sup- 
pressed menstruation, dysmenorrhea, amenorrhea, ovarian neuralgia, 
whether acute or chronic, the fomentation is indicated. Where pain 




Plate 53 — The Fomentation — Removing Water with Wringer. 




Plate 54 — The Fomentation — Removing Water by Using a Twisted Towel. 




Plate SS— The Fomentation — in Positi. 




Platk 56 — The Fomentation— Completed. 



THE TECHNIQUE OF HYDROTHERAPY. 123 

of any origin is presented — in headache, backache, "head-pressure" of 
neurasthenics, spinal irritation — it gives almost immediate relief. After 
surgical procedures its judicious application will give much relief and 
avoid the use of narcotics. For the relief of pain after divulsion of 
the sphincter ani it is a specific. The pain of strains, sprains and 
dislocations is relieved by the relaxation of tissue which it brings 
about. In facial acne it relieves the inflammation and congestion, 
stimulates the glandular structures and prevents the accumulation 
of sebum. The fomentation can be abused by too frequent use, and 
must, like all other measures, be adapted to the case in hand. Care 
must be taken to avoid "catching cold" after its use, as general per- 
spiration is usually present. In paralytics, in some forms of neuritis, 
and in all forms of myelitis or lesions accompanied by trophic troubles, 
the fomentation is to be avoided or carefully used. The author has 
been unable to discover any advantage from the addition of medicines 
to the water of the fomentation ; what we desire is moist heat at high 
temperatures. 

Compresses. 

The compress is one of the simplest of hydriatic procedures, but is 
in many instances a most efficient method of applying water to the 
treatment of disease. It consists of a number of folds of old linen, 
cheese cloth, or other suitable material of such size, shape and length 
as to conform to the anatomical lines of the part treated. If the com- 
press is to be greatly prolonged, a rubber bag or rubber tubing, through 
which water at the proper temperature is continually passed, may 
be applied over the compress to maintain the desired temperature. 
The malleable Leiter coil, a well-known tubular arangement, through 
which water of any desired temperature can be made to flow, offers 
an ideal method for maintaining the temperature of any compress, 
and their malleability enables them to be adapted to any and all ana- 
tomical irregularities. Where neither rubber tubing nor the coil is used, 
the compress must be frequently changed — in fact, renewed as soon as 
they have lost an undesired degree of their original temperature. 

It is important to know that if the cold compress is not renewed 
with sufficient frequency it will act less as a cooling and rather as a 
stimulating agent, an effect opposite to that of a true cooling compress. 
The compress of linen or cheese cloth is wrung out of water at the 
proper temperature and moulded to the part. It should be fairly 
wet, but not dripping. In the stimulating and hot compress the 
linen cloth is surrounded by several layers of flannel, or linen, or 
any impervious material of the same shape, but somewhat larger in 
every direction. The author prefers flannel, as it best prevents evap- 
oration or heat loss. This compress is a localized wet pack. Com- 
presses are classified by temperature : 



124 PRACTICAL HYDROTHERAPY. 

1. Cold compresses (cold, 50° F. and below; cooling, 55° to 
70° F.). 

2. Stimulating compress (50° to 70° F.). 

3. Hot compress (110° to 130° F.). 

The cold compress is used principally for its antithermic and anti- 
phlogistic effect, tending to subdue inflammatory conditions by direct 
heat abstraction, by inhibiting chemical and bacterial processes. This 
action can be enhanced by wringing out less water. In climates or 
under circumstances where cold water or ice cannot be obtained, we 
may have recourse to chemical means. Of this, Kellogg 1 says: " A 
very satisfactory substitute may be found in ammonium nitrate. This 
chemical substance has the property of absorbing an enormous amount 
of heat in passing from the solid to the liquid state. By adding to a 
quart of water eight ounces of nitrate of ammonium, a temperature 
of 41° F. was secured, the initial temperature of water being 70°, 
and the temperature of the room in which the experiment was made 
being 70° F." The stimulating compress differs from the cold com- 
press in that reaction is aimed at in order to secure a stimulation of 
the metabolic and vital processes locally. This compress should be 
allowed to remain on the patient until it is nearly dry. The hot 
compress is a means of applying heat locally, and for this reason an 
effort should be made to retain the heat as long as possible. It 
resembles the fomentation, but is not as revulsive or intense in its 
action. It increases the blood supply of the part, stimulates tissue 
change, causes local break-down and pus formation by enhancing 
local nutritive processes. It is a cleanly substitute for the "old- 
fashioned poultice." The action of each may be intensified by brief 
interruptions and alternations of temperatures ; thus a cold compress 
will be more effective if at proper times a brief hot application is made, 
and vice versa. When once the physiological action of the cold, 
cooling, stimulating and hot compress is understood it becomes un- 
necessary to study these effects as applied to each subdivision, for a 
compress, whether it be to the head, foot, leg, trunk, chest or throat, 
is a compress, and may be cold, cooling, stimulating or hot, may be 
alternated, hot or cold, without the necessity of considering separate 
physiological action. 

Physiological Action of the Cold and Cooling Compress. — The 
first effect of the cold and cooling compress when applied to the 
surface of the skin is contraction of the superficial tissues and blood- 
vessels, thereby restricting the amount of blood in the part to which 
the compress is applied, at the same time causing an increased activity 
in blood-vessels reflexly related to this surface. As the aim is to 
avoid reaction, it becomes necessary to maintain a constant tempera- 
ture, which can be attained by frequently renewing the compress, or, 

1 Kellogg, J. H. : "Rational Hydrotherapy," p. 773. 




Plate 57— Stimulating Compress— Compress in Position. 




Plate 58— Stimulating Compress— Completed. 




Plate 59— Coil Cap to Head. 




Plate 60— Precordial Compress and Ice Bag— the "Hydrotherapeutic Digitalis 



THE TECHNIQUE OE HYDROTHERAPY. 125 

what is better, use rubber tubing, Leiter coil or ice-bag, by means of 
which a uniform temperature can be kept up for some time. As the 
skin absorbs the cold a decided impression is made upon the peripheral 
nerves underneath the compress. With the prolonged cold the sensory 
and other nerves become very much benumbed, thereby abolishing all 
the intricate reflex actions that arise from an ordinary application of 
cold by the semi-anesthesia induced. This is followed by a secondary 
dilatation of blood-vessels in vascular areas associated with the com- 
press, which serves to further drain the blood from the part treated, 
although there is a constant tendency on the part of the circulation to 
overcome the cold by an afflux of arterial blood to the area. Exuda- 
tion, tissue change and circulation are restricted because of the 
lessened quantity of blood and diminished local nerve action. The 
blood stream becomes slower, the surface bluer from the presence of 
reduced hemoglobin in the veins. The contraction of the vessels of 
the area remains so long as the temperature is maintained. Its 
influence upon the blood itself is to diminish the hemoglobin and 
thereby decrease its oxidizing power, increase the reduced hemoglobin 
in the veins, lessen exudation of the serum, retard leucocytosis and 
decrease the red corpuscles. The temperature of the part is reduced 
from two to five degrees, and this can be maintained by a careful and 
judicious changing of the compress. This diminution in temperature 
we are prepared to accept when we realize the lessened circulatory 
and tissue change taking place. It is for these reasons in the early 
stages of inflammatory troubles that the cold or cooling compress has 
gained its reputation as an antiphlogistic, its usefulness being greatest 
where the circulation is still active or open in the part affected. 

L'pon the muscular system it is an inhibitant, lessening activity 
and movement — true of both striated and non-striated tissue. Its 
action reflexly upon muscular tissue is best noted in the application 
of a compress or the ice-bag over the heart in case of a cardiac in- 
sufficiency or rapidity. After a moment cardiac action is fuller and 
blood pressure raised. Long-continued application of cold over the 
heart depresses cardiac activity. 

Where the cold or cooling compress is continuously applied to the 
head the influence is less marked upon the circulation than any other 
region of the body. The general systemic temperature may be 
reduced, for the bones of the skull, being thin and covered with soft 
parts that are free from subcutaneous fat and thick muscular layers, 
the cold conveyed by conduction to the cerebral thermic centers lessens 
heat production. 

Therapeutics of the Cold and Cooling Compress. — From the fore- 
going physiological action it is at once apparent that the chief and 
most valuable use for this compress is in localized inflammations and 
where it is desired to limit the quantity of blood circulating in a part. 



126 PRACTICAL HYDROTHERAPY. 

Applied to the head it relieves headaches, especially where the pains 
are of a "nervous" type, or associated with hyperemic or "congestive" 
states. Care must, however, be exercised in continuous application, 
as stubborn and persistent pains of a neuralgic character may follow 
its use. In the delirium of fever, in meningitis, mania, "cerebral 
congestion," it is valuable, relieving pain, reducing fever and in- 
flammation. 

The hydriatist finds it a valuable measure to prevent retrostasis 
that would otherwise occur at the time of the application of heating 
procedures. In women who refuse to have the hair made wet the cold 
or cooling compress applied around the throat will serve the same 
beneficent purpose. In inflammatory diseases of the chest it has some 
ardent advocates. Mays 1 speaking especially of the local use of the 
ice-bag. In this field its action is, in my opinion, limited, the stimu- 
lating compress being better. From a wide experience with the cold 
compress and ice-bag in cardiac diseases the author can speak of its 
remarkable and valuable efficiency. This is so true that I have ofte# 
wondered why the general practitioner never uses it in the cardiac 
insufficiency of fevers or diseases of the heart itself. In endocarditis 
and myocarditis it controls the inflammatory process, strengthens 
heart action and relieves distress, the only contraindication being 
degeneration of the heart muscle itself. Syncope due to heart failure, 
as well as cases of rapid pulse functional in character, soon respond 
to its use. I have found it the most satisfactory method of reducing 
the rapid, feeble and thready pulse-rate of exophthalmic goitre, using 
it intermittently, two to four times daily, for twenty to thirty minutes 
at a time. Applied over the stomach and used in conjunction with 
small pieces of ice swallowed, it is an efficient antidote to vomiting. 
Placed upon the spine opposite, just below the wing of the scapula, 
it relieves pains of all kinds in the stomach, even those of cancer and 
ulcer. The ice-bag and compress used over the stomach and intestine-'- 
reduce hemorrhage. Used half an hour before meals, it increases 
appetite and the secretion of gastric juice. In appendicitis it may be 
employed as a supplemental measure to Ochsner's method. 

In typhoid fever the cooling compress is a useful adjuvant to the 
cold sponge, and should be placed over the large areas of the back, 
chest and abdomen, especially the latter. In inflamed and prolapsed 
hemorrhoids, and the testicle in orchitis, pain is relieved, inflammation 
diminished and comfort secured. Applied to the throat, it relieves 
inflammations, whether they be of an ordinary bacterial or post- 
operative kind ; in fact, in preventing post-operative inflammations, 
this compress has been of signal service in the hands of the author, 
particularly where it is later followed with the stimulating compress. 
In the early stages of inflamed joints, wounds and like conditions in 

2 Transactions Philadelphia Medical Society, 1895, p. 30J. 





Plate 65 — Permanent Throat Bandage. 




Plate 66 — Joint Compress. 




Plate 67 — Throat Compress. 



THE TECHNIQUE OF HYDROTHERAPY. U7 

the extremities, it has a markedly sedative and curative effect. If the 
ice-bag is laid across the trunk of an artery it is more effective in 
reducing the blood supply of the part to which the artery is dis- 
tributed than an application made directly to the part itself; and an 
application made to the axilla, the bend of the elbow or knee will 
control inflammation in the distal portion of the limb more effectively 
than a cold application to a hand or foot. It must be borne in mind 
m making an application of the ice-bag or of ice in any form that a 
compress be placed between it and the skin, preferably wrung out of 
very cold water. 

Physiological Action of the Stimulating Compress. — The aim in 
this compress is to secure reaction, and unless this is attained its 
object is defeated. Its effect is very similar to that of the pack, to be 
hereafter described, except that it is more localized and circumscribed. 
The cold of the stimulating compress causes the cutaneous blood- 
vessels to contract vigorously, through direct and reflex action, driving 
the blood out of the area and lessening the circulation. Varying with 
the temperature of the compress and the reactive capacity of the 
patient, there ensues a dilatation or hyperemia of the parts surrounded 
by or in contact with the compress. With the increased circulation 
of arterial blood in the part the compress becomes heated, the im- 
pervious flannel covering preventing dissipation and favoring accurrtu 
lation until the compress gradually attains and rises slightly above 
the temperature of the parts with which it is in contact. If continued 
the compress gradually becomes dry, evaporation of the water taking 
place. By reflex action of the vasomotors the deeper blood-vessels 
related to the parts, both anatomically and reflexly, contract, enhancing 
the blood supply beneath the compress. Its influence upon the 
peripheral nerves is sedative, for it envelops them in a moist warm 
vapor, making the nerve terminations more succulent, thus reducing 
their irritability. When the action is fully established it diminishes 
irritation in nervous structures reflexly related to the area. Local 
tissue change is enhanced, the active and improved blood supply 
removing waste material. Upon muscles it has a tonic influence, 
enhancing tissue change in them and improving their tone. Winter- 
nitz 3 has called our attention to the fact that the blood itself is 
influenced by local stimulating compresses, increased the hemoglobin, 
red blood cells, and in moderate degree leucocytosis, there being a par- 
ticularly noticeable increase of the red blood cells. 

It will, of course, be realized that with the increased temperature 
and other physiological reactions bacteria and toxins are neutralized 
and more rapidly removed from the part. Should chilliness be 
experienced it will be due to a failure of the part to react, which can 
be counteracted by at once removing the compress and applying 

3 Blatter f. klinische Hydrotherapie, p. 94. 



128 PRACTICAL HYDROTHERAPY 

friction or colder water. Where patients have feeble reactive power 
it is well to first commence with milder temperatures. 

Therapeutics of the Stimulating Compress. — In inflammatory dis- 
eases of the throat, and especially in tonsillitis, this compress is most 
effective, and under its influence the process rapidly ceases. In post- 
operative cases, where stimulating compresses have been carefully 
and persistently used by the author, healing has been accelerated 
nearly 40 per cent. This compress should be more utilized by the 
throat specialists than it is. In chronic catarrhal conditions of the 
tonsils, pharynx and larynx, the persistent and painstaking use of 
compresses will do much. In pneumonia we find a valuable adjuvant 
in the chest compress applied as Baruch 4 says, "every few hours 
when the temperature is above 102.5°, and removed when it falls 
below 100° F. The cold compress produces deep inspiration, con- 
tracts the cutaneous vessels, which rapidly dilate, and soon forms a 
soothing poultice, maintaining tonic dilatation, which aids the heart in 
propelling the blood through the contraction of the vascular ends 
which warm applications would paralyze by relaxation. That tem- 
perature is also reduced by wet compresses in pneumonia has repeat- 
edly been observed." In chronic bronchitis where access cannot be 
had to other measures, the stimulating compress offers an excellent 
means of allaying cough, increasing expectoration and bringing about 
resolution. 

The stimulating compress has received the commendation of 
the best authorities, not only for its influence in encouraging vital 
resistance in the diseased structures, but for the purpose of main- 
taining and lengthening the reduction of temperature secured by the 
Brand or full bath. It finds a useful field in all forms of inflammatory 
trouble of the gastro-intestinal tract (gastritis, enteritis, colitis, 
hepatitis, appendicitis, peritonitis). During the interappendicial 
period the wearing of a wet stimulating compress over the right iliac 
region is a valuable means of preventing a recurrence of the con- 
dition, and should be used more by the physician and surgeon than they 
are in the habit of doing at the present time. In the various forms 
of rheumatism this compress may be used as well as in many cases 
of old exudations in the extremities or near the surface of the body. 
It should be distinctly understood, however, that in these cases there 
are very much more satisfactory methods in handling the case than 
by means of the compress, especially the use of superheated hot air 
followed by the more active hydriatic measures. In old ulcers of the 
leg the application of a wet gauze compress, together with the spiral 
reverse bandage, is a method sanctioned by long and successful 
usage. 



4 Baruch, Simon: •'Hydrotherapy," 1897, p. 295. 




Plate 61— Chest Compresses. 




Plate 62— Chest Compress— First Stage. 



/ 





* 




Plate 63 — Chest Compress — Second Stage 



ttow*^ . — . — i 



I' 



Plate 64 — Chest Compress — Completed. 



THE TECHNIQUE OF HYDROTHERAPY. 129 

Hot Compress. 

This compress is applied similarly to the stimulating one, the ob- 
ject being to retain the heat. The material used should be ample, 
and larger than the area to be covered. The linen, blanket, cheese- 
cloth, etc., may be covered or protected by flannel or any other suit- 
able material. The method I generally employ is to have the patient 
lie upon the couch or bed ; the part to be treated is exposed and lubri- 
cated with vaseline. The compress is applied at the temperature de- 
sired, care being taken to wring the material sufficiently dry to pre- 
vent burning. If the clothing, bed or couch gets wet, it is likely to 
chill the patient and later cause a "cold." The rapidity with which 
a nurse works will have something to do with the efficiency and results 
of the hot compress. The duration of the application varies accord- 
ing to the temperature of the compress, the temperature of the room 
and the amount of water contained in the compress itself. It is a 
good plan, after several very hot compresses, to apply a hot-water 
bottle over the compress. Compresses are usually used to relieve 
pain; a safe rule is to remove, re-wet and replace them every half-hour 
as long as the pain is mitigated. Every hour a momentary stimu- 
lating effect can be obtained by using a cold (50° to 60° F.) compress 
for thirty seconds, then reapplying the hot compress. It should be 
remembered that a hot compress is always to be followed by a brief 
tonic application of cold, which should not exceed one-half minute. 
The parts are then well dried, finished with manual friction, covered 
with the patient's underwear or some other covering, remembering 
that evaporation and slow chilling defeat the object of this procedure. 
"In an emergency a flannel cloth or a cloth of any sort may be 
wrung out of water and wrapped around a stovepipe, or laid upon 
the top of a stove, or held against its side for a few seconds until 
heated. To prevent soiling by contact with the stove, the cloth may 
be placed between the folds of a newspaper ; the newspaper, being 
moistened, will not burn." (Kellogg.) 

The final application of cold produces a reaction, tonic and circula- 
tory in character. (See Fomentation.) 

Physiological Action of the Hot Compress. — The immediate influ- 
ence . of the hot compress is hardly pleasurable, and produces con- 
siderable excitation for a short time. Its action, though similar to 
the fomentation, is not nearly so powerful or excitant. Immediately 
upon its application there occurs a transient contraction of the blood- 
vessels, quickly followed by dilatation. After a short while, vaso- 
motor paresis takes place ; the vessels, large and small, dilate enor- 
mously, the skin assuming a red and turgid appearance. This paresis 
of the blood-vessels produces a slowed circulation, and is a "passive 
hyperemia." By local and reflex action of the vasomotors the ves- 



130 PRACTICAL HYDROTHERAPY. 

sels of the deeper structures related to the parts, both anatomically and 
reflexly, contract, while those at the surface fill with blood, a collateral 
anemia taking place in the deeper associated areas. This collateral 
anemia is an explanation of why hot compresses relieve deep-seated 
inflammations. Upon the peripheral nerves it is at first excitant, soon 
followed by marked sedative effects. The pain sense is dulled; the 
nerve terminations enveloped in hot vapor are rendered succulent 
and their irritability reduced. Reflex action is lessened, local tissue 
change is enhanced, migration of white cells increased, and the lymph 
stream made active. Upon the muscular system it has a relaxing 
effect, too well known to comment upon, probably no remedy being 
so efficacious in cramps of all kinds. Upon the blood Baruch" noted 
the following: 

"In order to ascertain the effect of warm compresses, the compo- 
sition of blood from the finger tip and from the skin over the abdo- 
men was studied. The finger tip blood showed 95 per cent, of hemo- 
globin and 5,300,000 red cells ; the blood from the abdominal skin 
showed 120 per cent, of hemoglobin and 7,000,000 red cells ; while 
the leucocytes were 7,000, about the same in both specimens. After 
a warm compress (127° F.) had lain for one and one-half hours 
upon the abdomen a comparison was again instituted, showing that 
in the blood from the finger tip the hemoglobin had increased 10 per 
cent, and the red cells 90,000; the leucocytes had also increased 1,000. 
But the blood taken from the skin of the abdomen beneath the cata- 
plasm had lost 22 per cent, of its hemoglobin and 2,500,000 of its red 
cells, while the leucocytes were doubled." 

Influencing circumscribed and local inflammations by Ieucocytosis, 
suppuration is brought about when this is desired, constituting, as 
it does, a clean, neat and valuable substitute for the old-fashioned 
poultice. It quickens metabolic changes, encourages absorption of 
exudates, and probably, through its high temperature, helps nature 
to destroy morbific products, just as fever is now considered by many 
to be beneficent, and to aid the natural resources in their fight against 
enemies, toxic and bacteric in character. 

Therapeutic Action of the Hot Compress. — It is valuable for its 
pain-relieving qualities. In acute pains, due to trauma, irritation, 
stasis or swelling, whether located in muscle, skin, nerve, bone or 
joint ; spasms, synovitis, toothache, earache, anemic headaches, mi- 
graine, inflammations of the throat, tonsils, etc., great relief is given. 
It may be employed to stimulate absorption and remove swellings 
or effusions. In inflammatory conditions of the abdominal and pelvic 
viscera, by its pain-relieving, relaxing and absorbing influence, it may be 
applied directly over any of these organs, the congestion of which will 
be relieved by the afflux of blood to the skin. In chronic pains, even 
of organic disease, if applied thoroughly, it will do major service and 

5 Loc. at p. 124. 






Plate 68— Pelvic Pack— Ready. 




Plate 69 — Pelvic Pack — First Stage. 




Platf. 70— Pelvic Pack— Second Stage. 




Plate 71— Pelvic Pack— Completed. 



THE TECHNIQUE OF HYDROTHERAPY. 131 

give much temporary relief. In all forms of gastro-intestinal inflam- 
mation, in hemorrhoids, after divulsion of the sphincter ani, this 
compress is indicated. It must be stated, however, that, as a rule, 
the fomentation gives better results. 

The Cephalic Compress. 

The head compress is probably the most generally used of these 
applications, and is utilized by the lay member more or less constantly 
in the treatment of various conditions of cerebral discomfort. One 
of the most satisfactory, and at the same time simple, methods of 
applying the compress to the head, is by means of a towel in the form 
of a turban. A towel of sufficient length and size is placed under 
the patient's head, on a line with the top of the ears ; the left end is 
first brought over the forehead and carried around to the occiput; 
the right side is carried around in the same manner and the open end 
turned to form a closed end, resting on the forehead, somewhat re- 
sembling the Tarn O'Shanter cap. The towel should be dipped in 
water at a temperature ranging from 40° to 60° F., and repeated at 
short intervals. The writer has also utilized the head-coil and ice-bag 
in connection with the compress, and has found that it is very much 
more satisfactory than the use of the head-coil or a compress alone; 
in fact, the head-coil should never be applied without some light com- 
press between it and the scalp. The cold compress is used by the 
hydriatist constantly during the application of heat upon the surface 
of the body, for such measures tend to produce retrostasis, or "rush 
of blood to the head." It therefore finds a useful place during the 
application of the electric light, arc, hot-air baths, and during the ad- 
mininstration of the various forms of packs. 

The Throat Compress. 

The throat compress is rarely properly applied, for, while it is 
generally termed throat compress, the aplication in ordinary hands is 
more often to the neck, rather than to the organs of the throat and 
upper throat. The writer has found in his experience that the in- 
volvement of pharynx, tonsil and larynx is so common, both by simul- 
taneous invasion or rapid extension from one to the other, that he 
has gradually evolved the following method of applying the throat 
compress : A piece of old linen is taken of sufficient length to pass 
around the neck and over the head once, after being folded twice 
upon itself to make four layers. Starting on the left side of the head 
below the left ear, the compress is carried over the top of the head, 
over the right ear, and then encircling the throat. In like manner 
a flannel bandage is carried over the linen compress several times, 
and applied with sufficient tension to cause the compress to fit closely 
and snugly in contact with the skin. Slits are then made in both the 



132 PRACTICAL HYDROTHERAPY 

compress and flannel roller, to permit the egress of the ears. The 
writer has found in his experience that it is much better to cut and 
measure the compress and bandage before putting them on the pa- 
tient's head. The linen is immersed in water at a temperature from 
50° to 60° F., and wrung out sufficiently dry to prevent dripping. 
Where it is necessary, as in restless adults or children, to secure the 
compress tightly, it is well to take a turn or two with the roller from 
the forehead to the occiput, thus encircling the head. The whole com- 
press will be made more secure and retain its position better if the 
crossings are pinned with small safety-pins. The object of this 
compress is to bring under its influence the skin and organs contained 
within the two triangles that have for their apex the ear and for the 
base the clavicle, for unless the compress reaches up and over the 
angle of the jaw, it is practically valueless, as the tonsils are prin- 
cipally involved. It is generally used for acute inflammatory troubles. 
A special "permanent bandage" in the shape of a spring collar has 
lately been placed upon the market," which enables this useful com- 
press to be easily applied. It is made of elastic celluloid, with raised 
sides, the inner side of which is lined with soft felt, which is moist- 
ened with water at the desired temperature before it is used (see cut). 
It is quickly adjusted and remains well in place. It is made in sizes 
ranging from ten to twelve inches to fifteen to eighteen inches, and 
is very moderate in price. 

The Chest Compress. 

The compress, when used upon the chest, is usually a stimulating 
one — in reality, a chest pack — and for this reason it must be so ap- 
plied as to exclude all air. The simplest way is to make several 
jackets (see cut). Take a piece of linen large enough to go around 
the chest, and lap eight or ten inches, and to extend from the clavicle 
to about the last rib. Place this beneath the patient, and draw around 
the body until the ends lap. Now cut slits for the arms, which are 
then enlarged to snugly fit these members ; then stitch the three lay- 
ers together. In the same manner prepare two flannel jackets, an 
inch longer at the neck and two inches at the abdominal end. Being 
rear'v to apply the compress, dip it in water at a temperature from 50° 
to 60° F., and wring out until it no longer drips. Now spread out 
the flannel jackets and lay upon them the wet compress, being care- 
ful to get the slits in the compress and flannel jackets in proper appo- 
sition ; fold or roll from each end until the compress presents a 
double roller appearance (see cut). Turn the patient gently on the 
right side, without the slightest exertion on his part ; place the rolled 
compress on the bed and unroll the left half, slipping the left arm 
into the left slit (see cut), and quickly placing the compress upon the 

6 Kny-Scheerer Co., 224 Fourth Avenue, New York City. 




Plate 72— Full Wet Pack— First Stage. 




Plate 73— Full Wet Pack— Second Stage. 




Plate 74— Full Wet Pack— Third Stage. 




Plate 75— Full Wet Pack— Fourth Stage. 



THE TECHNIQUE OF HYDROTHERAPY. . 133 

chest. Repeat the same process with the right side, and then allow 
the patient to lie upon the back; the ends of the compress are first 
lapped, then the underneath flannels carried closely and snugly over the 
compress. In like manner the outer flannel is tightly adjusted and 
secured by safety-pins in front. The upper edges are now neatly 
tucked around the neck and secured by safety-pins upon the shoulders. 
A soft towel or strip of linen is then tucked in at the neck to prevent 
the disagreeable irritation of the flannel (see cut). The chest pack is 
of value in inflammatory processes of the lungs and pleura. 

The Trunk Compress. 

The trunk compress may extend from the axilla to and over the 
hips, thus embracing the chest, abdomen and pelvis. Where it is lim- 
ited to the chest, abdomen or pelvis, it is generally called by 
the name of the anatomical region embraced. In its essential fea- 
tures it is one and the same. If it is to be used as a cold or cooling 
measure, one or two heavy crash towels are wrung out of water at the 
desired temperature (40° to 70° F.), applied to the region, and re- 
newed as frequently as they become warm. If a stimulating or hot 
compress is used, a single blanket is folded once lengthwise and 
placed under the patient's back (see cut), the compress, wrung out 
of water at the proper temperature, placed in position (see cut), and 
the blanket wrapped tightly over same. If a pelvic pack alone is 
given, we may better apply same by a sheet and two blankets, which 
are prepared as follows: The first blanket is folded lengthwise and 
placed across the bed so that the patient's back rests upon the middle. 
The second blanket is then folded so as to form a triangle, the apex 
of which is placed between the patient's legs. The sheet is similarly 
folded — about two inches smaller, however — and fitted on the second 
blanket (see cut). This compress or pack is generally given very 
hot, and is known as the "hot pelvic pack" or compress. The patient 
elevates the night dress, exposing the pelvis, and lies so that the apex 
of the second blanket is between the legs. The nurse now pours boil- 
ing water over the sheet (the wringer is very useful, see Fomenta- 
tion), rapidly places it in position, draws up the apex point between 
the legs fiist, then the two side ends, until the sheet now resembles 
an infant's napkin (see cut). In like manner the triangular blanket is 
applied, and over all the blanket folded lengthwise. This must be 
snugly done, air excluded, and secured in place by safety-pins (see 
cut). A rubber sheet will further prevent heat loss. The hot pelvic 
pack is a favorite method with the author. 

A stimulating compress, much used in Germany, and called "Nep- 
tune's girdle," consists of a linen bandage ten to twelve inches in 
width and three to four yards in length. One-third to one-half of 
this length is wrung out of water at 50° to 60° F., applied to the ab- 



134 PRACTICAL HYDROTHERAPY. 

domen or pelvis, as the case may be, and the dry half wrapped 
around the wet and pinned. It is of undoubted value in gastrointes- 
tinal affections, in which field it has obtained its greatest popularity. 

The Joint Compress. 

This is simply a piece of linen wet in water at 50° or 60° F., en- 
veloping the joint, and secured in position by a flannel bandage or 
some other proper material. Its action is obvious, and it is princi- 
pally used in inflammations of the extremities (see cuts). 

The Wet Pack. 

The full wet pack is one of the most useful and valuable of all 
hydriatic procedures, and should be more extensively employed, for 
it can be utilized in home or hospital practice, and where judiciously 
used will yield results the equal of many more vaunted procedures. 
There is no method, in my opinion, in the wide range of hydrotherapy, 
that it is so often faultily applied as the wet pack. It is best applied 
upon a cot or bed, over the mattress of which a rubber sheet has 
been spread. The following manner of proceeding has been found 
best by the author: 

Two large woolen blankets, preferably gray in color, are spread 
upon the mattress and allowed to hang over the cot equally on 
either side. The blankets should be long enough to extend at least 
eight to tweive inches below the feet, and the end above must come to a 
level with the ears. A rough linen sheet is now zvell zvrung out of 
water at a temperature varying from 50° to 80° F., appropriately 
graduated to suit the case. The sheet is spread upon blankets so 
as to leave a few inches of blanket margin at the neck end. The 
patient, completely disrobed, places himself upon the middle of the 
sheet, with his arms and legs slightly separated from contact with 
the body or themselves. The patient should be made to lie so as to 
allow three inches of the sheet to project above the shoulders. 

The nurse, standing on the left side of the cot, grasps the upper 
left hand corner of the sheet, and has the patient raise the arms ; 
the sheet is then brought under the left arm, across the chest, and is 
tucked snugly around the neck and under the right side of the trunk; 
the right leg is then raised and the sheet carried over the left leg and 
under the right one. The arms are now lowered and the upper right 
hand corner of the sheet brought over the right arm, over the chest, 
over the left arm, and is then tightly tucked under the left side of the 
trunk. The upper edge should now be folded and tucked around 
the neck and under the chin. The lower edge is then carried over the 
right leg and tucked under the left, and the open end below the feet 
loosely folded over the toes and feet and tucked under the heels. A 
fold over each shoulder will help to make the sheet lay smoothly 




Plate 76— Full Wet Pack— Fifth St; 



age. 




Plate 77— Full Wet Pack— Sixth Stage. 



ti£ 





Plate 78— Full Wet Pack— Seventh Stage. 




i 





Plate 79— Full Wet Pack— Completed. 



THE TECHNIQUE OF HYDROTHERAPY. 135 

around the neck. If properly done, every bit of the cutaneous sur- 
face is in contact with the sheet, except that of the face and head. 

The next step is to apply the blankets. In a manner similar to 
the application of the sheet, the upper left hand corner is carried 
across the trunk. The lower left hand end is then carried over 
the left leg, and the lower limbs closely drawn together. The right 
side of the blanket is then carried across and folded over the shoulder, 
trunk and legs. The nurse should now endeavor to pull the blankets 
as closely to the body as possible, for unless this is well done air will 
not be excluded, and the loosely applied blanket causes discomfort 
and fatigue. The second blanket is now applied over the first in like 
manner. The open ends at the feet are then folded closely together 
and turned under the feet. When completed, the patient is enveloped 
in sheet and blankets similar to a mummy. A soft towel is next taken 
and tucked around the neck to prevent the woolen fibers from irri- 
tating the sensitive skin of the neck and face. This assists in ex- 
cluding air. 

A cold wet turban or ice-helmet should then be applied. A simple 
way of applying the turban is as follows : Take two towels without 
fringes; place one upon the other and wring out of very cold water; 
wet the patient's hair with cold water and place his head upon the 
center of the edge of the towels; carry one side up back of the ear 
and fold over the forehead, and repeat on the other side; fold the 
loose ends squarely from behind forward, and a neat cap is formed. 
If this is not permitted, a cold circular compress may be placed around 
the neck, or a cold compress laid on the face. 

The time, usually required for a skillful nurse to apply a pack is 
about three minutes. It should at this point be again noted that unless 
all air has absolutely been excluded the aim of the pack has been de- 
feated. The sheet should be of rough linen, and it may be stated 
that a fair average temperature is 60° F., though patients should be 
educated to this temperature by several packs of a higher degree. If 
the patient desires water to drink during the pack, it should be given. 
A hot-water bag is comforting when applied to the feet, especially 
in those whose extremities are habitually cold. 

Physiological Action of the Wet Pack. — The first contact of the cold 
wet pack is disagreeable — a chililng sensation accompanied by tremor 
and shaking. Irritation of the cutaneous nerves by the cold, with 
contraction of the peripheral vessels, lasts until the individual's power 
of reaction comes into play. This depends, as in all hydriatic pro- 
cedures, upon the condition of the patient. Nervousness may be in- 
creased, but will disappear and give place to relaxation and calm 
when full reaction takes place. 

The efficiency of the application of the pack itself will have some- 
thing to do with the patient's reacting or "warming up," for chill in 



136 PRACTICAL HYDROTHERAPY. 

the pack may be due to the fact that at some points the wet sheet*is 
not in perfect contact with the surface. If this is the case, evaporation 
takes place, with cooling, instead of heat accumulation and vigorous 
reaction. If the feet do not warm readily, they may be left out 
until reaction is improved, or, what is better, the hot-water bottle 
applied for a short while. This stage usually lasts from five to fifteen 
minutes, when, reaction commencing, the system makes an effort to 
equalize its effects. The duration of the pack should range from 
thirty to sixty minutes, depending upon the effect desired — the shorter 
tonic and invigorating, the longer sedative. When reaction sets in 
and the peripheral blood-vessels dilate, the patient feels a delightful 
glow, a sensation of comfort and well-being. 

Upon the circulation, the pack at the outset produces peripheral 
contraction, driving the blood from the skin into the internal viscera ; 
the skin is pale and goose-flesh appears. During this stage Mueller, 
in trephined rabbits, noticed a rapid dilatation of the arteries of the 
pia mater. Usually, after a period roughly averaging ten minutes 
(this time being required, as there is complete lack of mechanical aid 
to dilatation of the blood-vessels), reaction takes place. The periph- 
eral blood-vessels dilate, the skin assumes a pinkish hue, the sheet 
warms up, the patient being now enveloped in a moist vapor. The 
entire bodily circulation is accelerated and the column of blood which 
sets in toward the viscera returns to the surface, assisted by the un- 
obstructed vascular conditions and better heart action, securing a more 
complete exchange between cutaneous and visceral blood. The pulse 
is accelerated at the commencement, but later becomes slowed, of 
fuller volume and better tension. The wet pack is a strain on the 
individual's circulation, as he has to depend entirely on his own vital 
capacity and resources for reaction. 

Upon respiration the first impression of the pack is one of dis- 
comfort and accelerated breathing. The patient may complain of 
thoracic constriction, which subsides with the onset of reaction, at 
which time the respirations become slow and deep, with increased 
absorption of oxygen, elimination of CO, and other waste materials. 
Expectoration is increased, noticeable in cases of inflammatory trouble 
of the bronchial tubes. 

Upon temperature the effect depends upon the duration of the 
pack. During the primary stage there is heat abstraction, but in 
non-febrile cases this is followed by increased heat production and 
accumulation due to the prevention of heat elimination. With 
reaction heat equalization takes place, with increased heat loss. With 
this increase of heat and the warming of the sheet, the' temperature 
generally rises sufficiently to produce perspiration. The thermic action 
is intense and the caloric response, like the circulatory, depends solely 
upon the patient's power to respond, and it was probably for this 



•gf 



1 1 • tit 





. 



Plate 80— Half Wet Pack. 




Plate 81— Hot Blanket Pack. 



THE TECHNIQUE OF HYDROTHERAPY. 137 

reason Priessnitz gave his packs early in the morning, before patients 
left their beds, while there was an accumulation of heat in the skin. 
If heat abstraction or antipyretic effect be desired, the packs, according 
to Liebermeister, should be repeated every ten minutes until five are 
taken. I do not consider the pack valuable as an antipyretic measure, 
much preferring the full bath or sponge and compress. 

Upon the nervous system its action is marked. The first periph- 
eral impression is a powerful one of discomfort and nervousness. 
With the onset of reaction comfort returns, after a short while the 
nervousness disappears, a sense of quiet and calm takes its place. 
The warm vapor bathes the peripheral nerves, renders them more 
succulent, less sensitive, and this is aided by the absence of any 
mechanical irritation. With the withdrawal of blood from the viscera, 
brain, etc., to the surface, drowsiness and later sleep are commonly 
produced, as central innervation dependent on the active blood stream 
will be lessened, though this is due to a combination of factors. The 
wet pack makes an appeal to every nerve in the skin and to all the 
various functions of the nervous system. The blood circulates in 
increased volume and under increased pressure through the nerve 
centers, and "in consequence, the acid fatigue products, which had 
been maintaining a permanent excitement of nerve elements, can be 
completely removed; the immediate subsequent diminution of the 
blood supply effected during the second part of the pack, cannot fail 
to be a great advantage, for it lowers the functional activity of the 
nerve tissues that has been unduly prolonged, and brings them, there- 
fore, into the condition which is a necessary preliminary to the be- 
ginning of nutritive assimilation. The diminution of the blood supply 
is not sufficient to interfere with this latter process, for it is not below 
the point which exists in sleep." (Jacobi.) 

Upon tissue change the pack has a decided alterative effect, all 
organic processes being vigorously excited to action. The heat 
abstraction by the cold induces functional activity ; with reaction and 
with temperature elevation there is a considerable destruction of 
toxins, together with elimination of waste tissue products. Proteid 
destruction and oxidation take place, the nitrogenous output being 
much increased. The neuro-vascular activity favors nutritive assimi- 
lation in the various tissues, and it is probable that auto-toxins are 
consumed in the powerfully enhanced combustion which represents 
the fever process, and that they are thus eliminated from the organism. 
"The so-called curative power of fever probably is due to this oxida- 
tion of toxins and auto-toxins, and it may also be the reason why 
sometimes chronic diseases are removed by acute intercurrent diseases, 
and why many individuals feel much better after acute febrile dis- 
eases." 7 

7 Kellogg, J. H. : "Rational Hydrotherapy," p. 608. 



138 PRACTICAL HYDROTHERAPY. 

Upon the muscular system the pack produces primarily con- 
traction, most marked in the muscular tissue of the skin, causing 
goose flesh. There is rigor and tremor during the cold stage, but 
later this gives way to muscular relaxation and lessened muscular 
irritation. Mosso, Maggiora and others have shown that the wet 
pack increases muscular activity and tonicity, and this explains the 
increased strength felt after the pack. Their tables showed marked 
improvement of lifting power. 

Upon the blood the pack not alone moves the stream through the 
blood-vessels more actively, but by causing increased elimination 
purifies it of many detrimental toxins and much waste material. It 
increases the oxygen-absorptive power of the red cells and the hemo- 
globin. Its bactericidal powers are enhanced, owing to the greater 
number of leucocytes. After a wet pack the blood stream is richer 
both in hemoglobin and all corpuscular elements, thus explaining its 
value as an adjunct to iron in the treatment of depleted blood states. 

Therapeutics of the Wet Pack. — If the aim be antiphlogistic, the 
pack must be administered at about 60° and repeated every ten minutes 
until the effect desired is attained, Liebermeister having shown that 
five such packs are equivalent to one Brand bath executed with 
every attention to detail. The wet pack at 60° F., like the full bath, 
is not administered with the sole idea of reducing temperature, but 
finds its greatest indication outside of its thermo-reducing value. 
That the full wet pack is a powerful tonic, an eliminator of toxins, a 
stimulator of renal and cutaneous activity; that it tones and refreshes 
the nervous system, steadies and improves cardiac action, is daily 
observed. In acute nervous affections ; in the restlessness of alcohol- 
ism, morphinism and other drug addictions, the wet pack serves as a 
calmative and sedative of very great value, and it is to be regretted 
that the general practitioner under whose care these conditions most 
frequently present themselves does not avail himself of a method the 
value of which remains undisputed and the technique of which is not 
difficult to acquire. An added incentive is the fact that all methods 
of drug medication will be enhanced and their physiological action 
more nearly attained. 

In chronic diseases the wet pack, because of its physiological 
action upon the nervous system, is most valuable. The author has 
found it a satisfactory remedial agent in the cure of insomnia, and 
uses it most frequently just before retiring. In all the functional 
psychoses and neuroses, especially neurasthenia, the wet pack, fol- 
lowed by active hydriatic methods, is of value, though I prefer other 
methods where the patient is up and going about. Where the 
nutritive forces are low, where secretion and excretion are dimin- 
ished, the pack will serve a useful purpose. In these cases it will be 
noticed from day to day that reaction is more and more prompt, 



THE TECHNIQUE OF HYDROTHERAPY. 139 

showing greater activity of neuro-circulatory response. In anemia, 
chlorosis and digestive disorders the pack can be used, but it is better 
to educate these cases to its use by a preliminary training with the wet 
sheet. The wet pack should be followed by some cold application — 
sheet bath, half bath, cold ablution, rain, jet, etc. — to restore tone to 
the cutaneous blood-vessels, and a proper selection can be made to 
meet the patient's needs and conditions. 

The only contraindications to the use of the pack are great feeble- 
ness, a very weak heart, vascular disease and some skin diseases. 

The Half Wet Pack. 

The half wet pack is a very useful procedure, especially where 
abdominal and pelvic conditions are to be met. It is easily applied as 
follows : 

Fold a blanket so that it will extend from the axilla to ten to 
twelve inches beyond the feet. Place the blanket across the cot or bed; 
fold a coarse linen sheet to come within two inches of the upper and 
lower ends of the blanket. Now wring the sheet out of water at from 
50° to 70° F., spread same on the blanket (see cut) and have the 
patient lie down on it so that the upper edge of the blanket 
reaches the axilla. Rapidly draw the sheet around the trunk, tucking 
it well under the body on either side and enveloping the legs as in the 
full pack (see cut). Likewise apply the blanket, being sure to draw 
the edges very tight. Cover the patient with bed clothing and apply 
a cold wet turban, cold water cap, or cold circular compress to the 
head or neck (see cut). 

The immediate and secondary effects are similar to those of the 
full pack, but less in degree. Patients react much more quickly than 
in the full pack, and it can therefore be more extensively, and fre- 
quently used. Its physiological action is similar and need not be 
repeated. 

Hot Blanket Pack. 

In some instances, where we wish to apply great heat to the entire 
body in the form of a pack, we may substitute for the sheet a blanket 
wrung out of very hot water, 120° to 130° F. (see cut).. The 
method of its application is then the same in every particular as the 
full wet pack, the aim being in this instance to retain all the heat 
possible. If desired, the blankets may be finally covered with a rubber 
sheet. 

The Dry Full Pack. 

This simple procedure is comparatively little used, owing to more 
valuable methods of securing the same results. The aim in the dry 
pack is to produce sweating, the excitation of perspiration being 
brought about by heat retention, the rough and irritating surfaces of 



140 PRACTICAL HYDROTHERAPY. 

the blanket serving to stimulate cutaneous hyperemia. This pack may 
be applied upon a bed or couch. Two blankets are first warmed and 
then spread upon a couch or bed, and upon these the patient reclines 
entirely nude. The upper left edge of the inner blanket is now 
carried under the left arm, over the body and tucked under the right 
side; then the right side is carried over the right arm, over the body 
and over the left arm and tucked under the left side. The left lower 
edge is carried over the patient's left leg and under the right leg. The 
right edge is then carried over both legs and tightly and snugly tucked 
under the legs. The bottom is closely folded from above downward 
and placed under the feet, where it is held by their weight. The 
second blanket is similarly applied. A towel is tucked around the 
neck to secure comfort. The patient now resembles a mummy. Addi- 
tional blankets should be used to cover him thoroughly. Care must 
be exercised to prevent "air currents," and the patient should be 
instructed to be still. If the blanket is pulled very tight comfort and 
freedom from muscular fatigue will be secured; if loose it is apt to 
make patients nervous and produce tickling. A hot-water bottle to 
the feet hastens perspiration. A cold cephalic compress prevents 
retrostasis. The blankets must be aired and kept clean and dry. 

Physiological Action of the Dry Pack. — The first effect of the 
blanket, if tightly and correctly applied, is to produce muscular relax- 
ation. The woolen strands irritate the skin. The blood-vessels of the 
skin dilate and the body is warmed. The skin becomes reddened, and 
as heat elimination is prevented it accumulates on the surface and 
shortly thereafter perspiration commences. As in other heating pro- 
cedures, the pulse at this stage is accelerated, the head is apt to feel 
full and a sense of discomfort is felt. With the outbreak of per- 
spiration the pulse becomes slower and the patient more comfortable. 
The time necessary for these phenomena varies, but is usually un- 
comfortably long to the patient. The duration may be lessened by a 
preliminary heating, by hot-water bottles around and under the extra 
covering. The dry pack is simply a preparatory procedure, and when 
used alone has little, if any, therapeutic indication. It may prove 
useful in promoting reaction in those who fail to respond to active 
cold methods. 

In connection with the electric light bath and fomentation, in 
sciatica, it has proved in my hands of some value as a protective 
during the application of the fomentation. It should always be 
borne in mind that in this, as in all procedures having for their object 
the heating of the surface and the production of perspiration, it 
must be followed by a heat-depriving measure, adapted to the heat 
accumulation and the patient's reactive power. A sensitive vaso- 
motor system, cerebral determination, in cutaneous hyperesthesias, in 
skin eruptions and in the very nervous, it should not be used. 




Plate 82— Foot Bath. 



THE TECHNIQUE OF HYDROTHERAPY. 141 

The half dry pack is limited to the trunk in its use, and extends 
from the axilla to the hips, the extremities being free. It is applied 
snugly to this region, and is employed for gastro-intestinal disorders. 
It has little value. 

Of all the measures used to prepare patients for hydriatics, the 
dry pack possesses the least value, and should not be used when 
there are other and more satisfactory methods at hand. It is slow, 
disagreeable and inefficient. 

Local Baths. 

The hydriatist is apt to describe in much detail the many local 
baths, hot, cold and neutral, of which we may mention the hand, arm, 
elbow, leg, foot, etc., as the principal ones. Their effects are similar, 
and differences that exist are due to anatomical rather than physio- 
logical changes, for they are in their finality limited to local and de- 
rivative action. As a type of this class we shall only describe the most 
frequently used one, viz., the hot and cold foot-bath. 

Foot-Baths. — The tub may be of wood, metal or porcelain, prefer- 
ably of the latter. It should be of sufficient size to admit feet of good- 
sized caliber without cramping, and yet at the same time permit some 
freedom of movement. In the arrangement of this tub, modern at- 
tachments must be used that will permit of the entrance of water 
from below, either between the feet or from the end toward which 
the toes are turned. 

In the use of the hot foot-bath, the tub is filled to the depth of 
four to five inches, or, if further derivative influences are sought, it 
can be filled so as to embrace the leg. The initial temperature should 
be about 104°, this being rapidly raised to the point of tolerance, so 
that by the end of two or three minutes the water has become as hot 
as 115° to 120° F. The duration ranges from five to thirty minutes. 
Its action may be slightly enhanced by moving the feet about slowly. 
As the water cools, more should be added to maintain the tempera- 
ture. It is desirable to retain the blood in the parts and secure tonic 
dilatation ; for this reason the foot-bath should be followed by a very 
brief cold application, such as a quick immersion in cold water, a pail 
dash or a cold spray, thus securing reaction. 

The local and general effects are those of the hot full bath, limited 
to the pedal extremities, which effects have been fully described. 
The hot foot-bath is a much-used family remedy in the treatment of 
incipient inflammatory troubles of the respiratory mucous membrane. 
It is also a derivative of no mean value in removing blood from the 
pelvic, rectal and lower abdominal regions, stimulating the involun- 
tary muscular fibers of these organs as well. In painful conditions 
of the feet, sprains, bruises, myalgia and neuralgia, these baths afford 
temporary and sometimes permanent relief where they are used fre- 



142 PRACTICAL HYDROTHERAPY. 

quently. The so-called "fullness of the head" from which neuras- 
thenics suffer is temporarily relieved. In certain surgical injuries, 
in ulcers, felons, burns, etc., the foot-bath, at moderate or neutral 
temperatures, fills a useful niche. 

The cold foot-bath is applied by means of the same tub at tem- 
atures ranging from 50° to 60° F., its duration ranging from one to 
five minutes. It is much less frequently used than the hot foot-bath, 
although it is not an infrequent application. It will be found that the 
effect of the bath is greatly enhanced by a short primary immersion 
of the feet in warm water. The patient should be instructed while 
the feet remain in the bath to chafe them constantly by rubbing one 
foot against the other. 

The physiological action of the cold foot-bath is in general that 
of the cold full bath already described. Its revulsive and reflex ef- 
fects are more extensive than those of the hot foot-bath. The action 
of the cold foot-bath is locally tonic, acting with especial selection upon 
the pelvic and lower abdominal viscera. By reflex action it causes 
contraction of the unstriped muscular fibers of the various organs and 
blood-vessels contained in these areas, and especially the muscular 
tissue of the uterus and bladder. Where the rubbing of the feet is 
maintained constantly during its application, it acts as a derivative 
upon the cerebral circulation, lessening the quantity of blood therein. 
This is equally true of local applications made to the hand and wrist, 
it being an interesting fact that the immersion of the hands in cold 
water will stop nose bleed, and during the heat of summer will do 
much to lessen the quantity of blood in the brain, as well as reduce 
temperature. It has been a frequent observation of the author's that 
the sudden application of cold to the feet will promptly cause an evac- 
uation of the bladder, a fact that has been utilized by him when un- 
able to secure a catheter. The very cold foot-bath of short duration 
is a most excellent measure for relieving persistent cold and sweating 
feet, in which cases it should be administered at a temperature of 50° 
F for one minute. In cases of insomnia, where they have been of 
short duration, and largely brought about by deficient circulation, 
this bath may be of some help, but my experience has been that such 
cases demand more extensive general procedures. One should be 
careful to avoid administering the cold foot-bath when any inflam- 
matory trouble of the pelvis, bladder or rectum exists. It should 
be remarked that localized conditions, such as chronic rheumatic 
troubles, neuralgia and some cutaneous diseases, forbid the use of 
this bath. 

It is interesting here to note that one of the most popular "fads" 
of recent years has had to do with the local application of wet cold 
to the feet and ankles. I refer to the so-called "Father Kneipp cure." 
This method came somewhat into vogue with certain fashionable, in- 



THE TECHNIQUE OF HYDROTHERAPY. 143 

active and over-fed people, who were prone to attribute the good re- 
sults obtained to walking through the grass while still wet with the 
morning dew. They seemed to ignore the fact that they were upon 
reduced rations, coarse food, and taking active exercise in the open 
air. They doubtless derived some benefit from the application of cold 
to the pedal extremities. Like most fads, it had its day, being literally 
"run into the ground." 

The Sitz or Hip Bath. — This is a very valuable local hydriatic 
measure that has been in use for a long number of years. The sitz bath 
may be administered by means of a sitz bath-tub made of metal or por- 
celain, the latter, of course, being preferable. The sitz tubs upon the 
market at the present time are all that could be desired by those contem- 
plating their purchase. It should be of such size that the patient can 
comfortably sit in the tub with the feet hanging out, and be provided 
with modern arrangements for the introduction of hot and cold water 
from the bottom. The rim should be broad enough so that there will 
be no necessity to flex the limbs and compress the popliteal space, for 
where this is done the circulation in the lower limbs is interfered with 
materially. Where the individual is short of limb it makes the bath 
more comfortable to have the feet supported. The tub should be 
filled with water of the proper temperature desired for the applica- 
tion to such a depth as will reach the level of the patient's umbilicus. 
During the use of this bath the upper trunk should be protected by 
some covering, either in the shape of a Turkish sheet or undervest, to 
prevent chilling. The patient must semi-recline with the back resting 
upon the back of the sitz tub, the limbs separated so that the lumbar, 
lower abdominal regions, outer and inner surface of the thighs, the 
perineum and external genitals are brought in contact with the water. 
When the cold sitz is employed the head should be covered with a cold 
towel or wet turban, and this may likewise be used during the hot 
sitz, although it is usually not required. 

The Cold Sitz Bath. — This bath is not only a valuable local appli- 
cation, but influences more or less all bodily functions. During its 
administration the attendant and patient should rub the external sur- 
faces in contact with the water, in order that the frictions may 
stimulate the cutaneous blood-vessels to dilate. This bath is usually 
administered at temperatures from 80° to 50° F. for five to fifteen 
minutes, according to the effect desired. It causes a contraction of 
the cutaneous blood-vessels of the area covered by the water, and 
from which the column of blood is driven inward ; this effect seems 
especially felt in the head, and may on certain occasions, as the author 
has demonstrated on his own person, be used to increase cerebral 
activity. This in practice calls for a cold turban or ice-cap to prevent 
the unpleasant feeling of fullness. With the application of friction 
the blood-vessels begin to dilate and a slight rosy hue is produced in 



144 PRACTICAL HYDROTHERAPY. 

the skin. With the dilatation of the peripheral blood-vessels under 
friction the column of blood is again directed toward the periphery 
and maintained there, and this maintenance of the blood in the skin 
acts as a tonic, and is in no sense a vascular paresis. The heart's action 
becomes stronger and better, the pulse slower, increased in volume 
and arterial tension raised. Temperature is reduced in the parts 
immersed, which will be compensated if the bath is of moderate 
duration. When reaction takes place, local temperature is elevated. 
If long continued a systemic reduction may take place. 

The influence of this bath is probably greatest upon the nervous 
system. The thermic impression rising from the impact of cold upon 
the surface is conveyed reflexly to the anatomically related areas in 
the pelvis, lower abdominal regions, and reflexly upon the whole of 
the spinal, central and sympathetic nervous systems. It stimulates 
the peripheral nerve endings, increasing their dynamic influence in no 
small way. Upon the spinal and sympathetic centers that preside over 
the genito-urinary apparatus this bath has a wide influence, brief appli- 
cations toning and stimulating these structures. Owing to the inti- 
mately correlated relations between the abdominal viscera and the skin 
of the lower abdomen and hips, we may by this bath so increase and im- 
prove the intricate chemistry of digestion and assimilation as to improve 
general metabolism. It is a clinically observed fact that functional 
activity in these organs is much enhanced. Upon the muscular struc- 
tures related to the bath, directly and reflexly, the cold sitz acts as a 
tonic, improving the power of contraction in the various viscera of the 
pelvic and lower abdominal regions. This is especially true of the 
functions of defecation and urination, upon which these baths possess 
potent power. The muscles of the abdominal wall and muscular 
ligamentous structures supporting the pelvic viscera are toned and 
strengthened by this application. It increases the elimination of waste 
products through the kidney and stimulates the outflow of bile, prob- 
ably because the portal circulation is much increased and its tension 
raised. 

The therapeutic application of the cold sitz bath is extensive, it 
being a powerful tonic to local functions. Where the muscular struc- 
tures of the urinary bladder are weak or paralytic in adults, and 
especially children who suffer from nocturnal incontinence of urine, 
the brief cold sitz is indicated. In weakened sexual power, with general 
loss of tone, in spermatorrhea, prostatorrhea, chronic congestions of 
the vesicles and prostate, this bath at 60° to 70° F. for ten to fifteen 
minutes will prove of signal benefit. In diseases of the pelvic organs 
in the female, where they are dependent upon low-grade chronic in- 
flammation:, relaxation, lack of tone, congestion, etc., where no pus 
is present, this procedure will prove tonic and stimulant in their re- 
lief. 



THE TECHNIQUE OF HYDROTHERAPY. 145 

In profuse menstruation Baruch 8 says that in those cases which 
"drag on from month to month, the patient exhausted and anemic, 
and thus establish a vicious circle which maintains the drain, when 
curetting has failed or is not indicated, the flow being maintained by a 
feeble local and general circulation, hip baths of five to eight minutes, 
in water at 85° F., with constant friction, followed by affusions or 
preferably by the circular bath and then douches at the same or a 
lower temperature, far excel all medicinal agents. It is the author's 
custom in such cases to order the hip baths on the fifth day of the 
menstruation, when the latter arrives at a distinct period, and to con- 
tinue it daily until the flow has ceased. If no distinct period exists, 
the hip bath should be ordered after the flow has become profuse, and 
it should be continued until the flow ceases. Not only will the drain 
be thus checked, but the tonic effect of such a bath will counteract 
the depreciated systemic condition and restore the patient's health and 
spirits. Most women object strenuously to the cold hip bath in 
menstrual disorders. It is therefore wise to forestall their fears by 
reassuring them of the necessity and great value of brief hip baths in 
these conditions." In diarrhea, dysentery and all inflammatory dis- 
eases of the small intestines, colon and rectum, the author has found 
the method of Winternitz the most satisfactory. The patient is given 
a dripping sheet, as heretofore described, followed by a cold sitz bath 
for ten to fifteen minutes, commencing with a temperature of 85° F. 
and gradually reduced to 60° F. Some cases do better at 70° rather 
than 60° F. The patient and attendant should be made to persist- 
ently rub the abdominal walls during the administration of the bath. 
Its action is to stimulate the sympathetic nerves, diminish peristaltic 
action, lessen secYetion and contract the intestinal blood-vessels. In 
jaundice, where the duct is open, in those who suffer from chronic 
deficiency of biliary secretion, the bile may be augmented through the 
use of this bath. Because of its muscular effects the cold sitz (50° 
to 60° F.) for five to seven minutes will overcome constipation. 
Where there is a therapeutic indication for an increased quantity of 
blood to circulate in the brain we have in the cold sitz bath a method 
of driving the blood to this structure. 

The cold sitz bath is contraindicated in all irritable and painful 
conditions of the abdominal and pelvic organs ; in acute inflammatory 
states such as cystitis, ovaritis, cellulitis, etc. ; in pus formation ; in all 
forms of muscular spasm ; in profuse uterine hemorrhage, and in 
acute inflammations of the rectum. 

Certain modifications hardly worthy of a distinct consideration 
consist in the employment of the so-called tepid sitz bath (68° to 
86° F.) for twenty to thirty minutes, it possessing some antiphlogistic 
power. In certain painful affections of the pelvic viscera, lower 

8 Loc. cit., p. 222. 



146 PRACTICAL HYDROTHERAPY. 

abdominal region and rectum the use of the alternating sitz is valuable. 
They may be either administered as a hot sitz (110° F. ) for ten 
minutes, followed by a short dip in a cold bath (60° to 70° F.) for a 
few seconds, or we may reverse the procedure by a short dip in a 
cold sitz followed by a five minutes' immersion in a hot sitz. The 
indication for the use of these measures will be found to be rare. 

The Hot Sitz Bath. — This is administered at temperatures ranging 
from 104 c to 115° F., somewhat higher in special cases. Its duration 
ranges from three to fifteen minutes, a fair average being about ten 
minutes. Most patients object to the immediate immersion of even a 
portion of the body in water at a temperature of 104° F. or higher, 
and for this reason it is well to commence the use of the bath with a 
temperature of 100° F., rapidly adding hot water until the maximum 
temperature is reached. This will be an easy matter in those modern 
sitz tubs where the water enters the tub from the bottom. In the use 
of the hot sitz bath additional derivative effects may be obtained by 
the use of the hot foot-bath. 

The physiological action of the hot sitz bath is that of a localized 
hot bath. The hot water causes an atonic dilatation in the cutaneous 
blood-vessels, especially those of the external iliac artery, brought 
about both by its direct and reflex action, the skin becoming reddened 
and intensely congested as paralysis of the vasomotor constrictors 
takes place. With this intense dilatation the quantity of blood in the 
pelvis is largely increased, the major portion being drawn from the 
area of the portal, although quite a good deal of blood comes from the 
general circulation. There is a noticeable increase in the pulse-rate 
and a slight diminution in blood pressure at this time. Temperature 
is elevated, coincident with which we find general perspiration, with 
increased local action of the glandular structures of the skin in con- 
tact with the water. Metabolism is enhanced, nitrogenized products 
being more rapidly oxidized into urea. The glandular structures of 
the pelvis are stimulated and discharge more freely their mucus. 
Upon muscular tissue brought under its influence it has a decided 
quieting, relaxing and antispasmodic effect. Upon the nervous 
mechanism anatomically related, it is a sedative of high value, re- 
ducing the number of impressions that arise from the periphery, 
owing to its heat and the more succulent and sedative condition of the 
cutaneous nerves. Pain and spasm are diminished and relief obtained. 
Its physiological action points clearly its use. 

The therapeutic application of the sitz bath has been known for 
many years, and is in many households a family remedy. It has 
probably been more frequently used and proven of greater service 
than any other hydriatic application in the restoration of painful and 
suppressed menstruation from whatever cause. In this condition it 
not only checks the pain and spasm that is present, but by materially 




Plate 85— Half Bath. 




Plate 86— Affusion to Back and Spine. 



THE TECHNIQUE OF HYDROTHERAPY 147 

increasing the quantity of blood in the pelvis favors bleeding, and 
therefore immediate relief. In its use care should be taken to prevent 
chilling afterward, and for this reason it is best administered just 
before bed-time, its action being maintained upon return to bed by 
the use of the hot-water bottle, etc. In the painful tenesmus of 
vesical catarrh of whatever origin, it is a remedy that will at once 
bring relief to the sufferer. Where there is retention of urine and 
inability to introduce the catheter this can frequently be accomplished 
and relief gained by introducing the instrument during the application 
of the sitz bath ; the water should be as hot as can be borne. In anal 
tenesmus, in inflamed hemorrhoids, in vaginismus, in various neural- 
gias of the ovaries and external genitalia, the hot sitz bath is an 
excellent analgesic measure. Where these latter conditions do not 
depend upon inflammatory conditions a very brief application of cold, 
such as an affusion, will enhance and lengthen the influence of the 
bath. In all forms of pelvic trouble where we desire a relaxing, anti- 
spasmodic, sedative and anodyne influence, the hot sitz bath will meet 
the indications. 

The Half Bath. 

This bath is administered in an ordinary bath-tub, which should 
be of sufficient length to permit of the patient's sitting comfortably 
with the limbs extended. The best tub is a porcelain-lined one, and 
should, in use, be filled with water that reaches to the level of the 
umbilicus. The temperature at which it is usually administered ranges 
from 85° to 50° F., although the latter is very rarely used. A fair 
average is from 75° to 65° F. Always commence with 85° or even 
90° F. and reduce the temperature two or three degrees daily until 
the desired point is reached. The tub is first filled to the proper depth 
and an ice-helmet placed on the patient's head, after which he steps 
into the tub and sits with the limbs extended, the attendant standing 
on the patient's right side, leaning over to apply the friction. During 
the bath the patient dashes water against the chest and arms, applying 
friction, while the attendant either dashes water from the tub against 
the back and sides with one hand while he applies friction with the 
other, or clashes water upon the patient from pails that stand beside 
the bath-tub. The author's experience has led him to use the fol- 
lowing method, which he believes is superior to the usual one of giv- 
ing the half bath: As soon as the patient seats himself in the tub, the 
attendant at once commences to chafe the surfaces of the lower limbs, 
spending approximately one-half minute upon each limb, while the 
patient applies friction to the lower abdominal wall and buttocks. 
The attendant then moves to the back, and with the left hand dashes 
water from the tub upon the back while he applies friction vigorously 
with the right hand, the patient in the meantime splashing water upon 



148 PRACTICAL HYDROTHERAPY. 

the chest and arms, rubbing them as vigorously as he can. This should 
occupy about two minutes ; the time may be lengthened proportionately 
to the duration of the bath. 

The duration of the bath should range from two to rive minutes, 
at the end of which time the patient receives an affusion, over the 
back and shoulders, of water several degrees colder than that in the 
tub. He is then lifted or steps out, and is rapidly rubbed down with 
Turkish towels until dry and good reaction obtained. Exercise may 
then be taken if indicated. 

The Physiological Action of the Half Bath. — This powerful tonic 
and stimulative measure more nearly resembles the douche than any 
method that does not employ apparatus. In general practice it may 
be used in place of the douche, and should take precedence over the 
much-abused "plunge." The repeated splashing of the water upon 
the skin surface, and the friction, influence the vascular state pro- 
foundly. With the first contact there will be a contraction of the 
surface tissues, paleness and lessened blood-supply. There is a gasp- 
ing respiration, sense of constriction and discomfort. As soon as 
the friction is applied the column of blood comes to the surface and 
fills the tonically dilated blood-vessels, which further dilate when 
reaction takes place. There is practically no heat abstraction, owing 
to the brief duration of the bath. Respiration is deepened, with better 
exchange of gases ; all phases of metabolism enhanced, and muscular 
power increased. It is a powerful tonic stimulant to the nervous sys- 
tem through the thermo-mechanical impressions made by the cold water 
and friction, and especially influences the functions of the spinal cord. 
For greater detail of these effects, the reader should peruse the sec- 
tion in which is detailed the physiological action of the douche. 

The therapeutic application of this bath is wide. As a substitute 
in private practice for the douche, it becomes useful in all those 
chronic diseases in which circulation, metabolism and nerve force 
need regeneration. The author has found this bath of unusual value 
in chronic organic diseases of the spinal cord, especially in cases of 
locomotor ataxia, chronic spinal meningitis, chronic myelitis and sim- 
ilar affections. In these diseases it is customary to use the half bath 
for two to five minutes, commencing at a temperature of 80° to 85° 
F., gradually reducing the. temperature of each succeeding bath until 
70° or 65 3 F. is reached. The friction should be well applied, strong 
enough to bring about a reaction in the bath, and sufficient to make 
the patient feel fairly comfortable. In the diseases mentioned, pain is 
usually a contraindication for its use, but I have seen good results 
follow these baths even when marked lancinating pains were present. 
The author has used with the half bath pine extract, mustard and other 
stimulating measures, but has never found them of any additional 
value, and now rarely employs them. Strasser has found the half 



THE TECHNIQUE OF HYDROTHERAPY. 149 

bath, at 65° to 70° F., for six, gradually increased to fifteen minutes, 
of service in the treatment of febrile and infectious diseases, for 
where it is sufficiently prolonged (fifteen minutes) and friction con- 
tinued, it abstracts heat, strengthens the heart and overcomes circu- 
latory weakness, arouses and tones the nervous system, lessens mus- 
cular weakness, favors metabolic changes and provokes diuresis. The 
author prefers either the sponge and compress or the full bath. In 
respiratory diseases, in hypostatic congestion, in bronchitis and other 
affections, the patient should be placed in a half bath at 90° F., and 
held in a semi-recumbent position by one nurse while another bathes 
the upper part of the body, and especially the chest, with water at 
50° to 60° F., or gives an affusion to the chest (see cut) at the same 
temperature. It will arouse, stimulate, and relieve even desperate 
cases. In anemia, chlorosis and other depraved blood states, it not 
alone increases hemoglobin and corpuscular richness, but causes the 
system to rapidly utilize iron, which had before seemingly been of 
little avail. It may be employed after the use of heating and sweating 
procedures in a similar manner to the douche. For this purpose it 
is popular with foreign hydriatists, although in this country the 
douche is much preferred. In neurasthenia, in the functional neuroses 
and psychoses, in the gastric disturbances, constipation and auto- 
toxemia accompanying them, the half bath will be found an excel- 
lent measure. 

The hot half bath is rarely employed by the author, the indications 
for its use being better met by the full hot bath or the hot sitz bath. 
One can vary the hot full bath by making it at first a hot half bath, 
if it is so desired. 

The cold half bath is contraindicated in acute inflammations of the 
abdomen and pelvis, in profuse uterine hemorrhage, in suppurative 
states in the pelvis, in painful nerve lesions of the lower extremities, 
in acute inflammations of the heart muscles and its membranes, and 
in acute inflammations and congestions of the central nervous system. 
It must be used with care and judgment in thoracic diseases. 



CHAPTER X. 
THE TECHNIQUE OF HYDROTHERAPY. 

(Continued.) 

The Very Hot and Hot Bath. 

These baths may be administered in an ordinary porcelain-lined 
tub of considerable breadth and fully seven feet long, in which the 
average patient can recline comfortably and yet have the shoulders 
well covered. A strap across the "head" of the tub can be arranged 
to support the patient's head, though this is not absolutely necessary. 
The water should enter at the "foot" of the tub from below, which is 
easily accomplished by the modern faucet arrangement. The tem- 
perature of the very hot bath ranges between 104° and 110° F. for 
Europeans and 130° F. for the Japanese; the hot bath ordinarily 
varies from 100° to 104° F. The difference of action physiologically 
between very hot and hot temperatures is one of degree. The Jap- 
anese can stand temperatures that are extremely painful to Europeans, 
but, as they have become habituated to these temperatures from youth, 
it is not surprising that they excel the "white man" in thermic capacity. 
There is a popular idea prevailing that the very hot bath is productive 
of diminished power of resistance, but this is disproved by the daily 
labor, capacity for endurance, and other wonderful traits exhibited by 
the Japanese. Too high a tribute cannot be paid to these people for 
their intelligent use of bathing and for their great personal cleanliness. 
The bath should be administered as follows : The patient's face and 
neck having been bathed in cold water, with cold compress or ice- 
helmet upon the head, he steps into the tub and reclines in water at 
100° F After the first momentary discomfort, the water should be 
rapidly raised to the temperature desired by the addition of hotter or 
very hot water. The duration of the bath ranges from two to ten 
minutes, being governed by the patient's condition and peculiarities. 
Friction during the bath in certain conditions is of value, aiding circu- 
latory effects. 

Physiological Action of the Hot Full Bath. — The first impression 
of very hot water upon the body surface is similar to that of cold, 
producing shivering, a sensation of pain and transient discomfort. 
This effect is of short duration, and is followed by relaxation and a 
sense of warmth. Its effects upon circulation are marked, the blood- 
vessels being first constricted and later dilated — in fact, becoming 
(150) 



THE TECHNIQUE OF HYDROTHERAPY. 151 

much distended with blood. The heart's action is increased, the pulse 
rapid and feebler as the temperature is raised, but tone is not alto- 
gether lost, this being more noticeable after the bath than during its 
administration. The skin is red, owing to the dilated cutaneous blood- 
vessels, the increased quantity of blood called to the surface being 
fairly proportional to the temperature of the bath. The internal blood- 
vessels are contracted through diminished quantity of blood and from 
reflex action. 

During its administration vascular tension is at first slightly raised, 
but is lowered immediately after reaction in and following the bath. 
Respiration is quickened and its depth lessened ; C0 2 elimination in- 
creased but oxygen absorption diminished. The temperature of the 
body is markedly raised by heat absorption and the prevention of heat 
elimination. The increased quantity of blood in the peripheral blood- 
vessels, unable to lose its heat, returns to the center of the body and 
raises internal temperature. 

Upon tissue change its action is spoliative, tending especially to 
break down lowly organized and inflammatory deposits. Upon mus- 
cular tissue it is a powerful relaxant, relieving spasm and pain. It 
has an agreeable and soothing influence upon overstrained and tired 
muscles, which is believed to be due to its destroying the toxic prod- 
ucts of fatigue by increased oxidation. In like manner it acts as an 
eliminant, destroying many toxic materials in the blood by its in- 
creased temperature and removing them from the body by subsequent 
diuresis. Upon the nervous system its action is primarily that of a 
powerful stimulant. The first impression is of discomfort and in a 
certain sense pain, but this is shortly followed by a feeling of comfort, 
relief from pain, and general relaxation. The thermic impressions 
traveling inward from the periphery set up reflex influences, especially 
of a vasomotor nature, with a resultant vascular dilatation. The brain 
and cord soon become anemic, as evidenced by a slight drowsiness, 
and, as shown by Schuller, a sense of cephalic pressure and a vertigo 
on rising from the bath. 

Prof. Baelz, of Tokio, has made accurate observations on the hot 
bath. Residing among a cleanly people, with whom hot bathing is a 
daily practice, there being four hundred thousand hot baths given 
daily in Tokio alone, he had exceptional opportunities for studying their 
effects. The temperature adopted by the Japanese is usually about 
130° F., while Europeans indulge in baths of 104° to 109°. F. The head 
is usually first bathed in hot water before the bath is entered, in order to 
relax and dilate the cerebral vessels, and thus prevent cerebral anemia 
when the cutaneous vessels become greatly dilated. This is also aided 
by the sitting posture usually assumed. Palpitation, oppression and 
a decided sense of great heat are regarded as a signal for removal. 
The first effect of such a bath is usually pallor and goose skin, 



152 PRACTICAL HYDROTHERAPY 

lasting a few seconds ; the pulse becomes slower, and afterward more 
rapid. At first the respiration is not much affected ; later it becomes 
more rapid and purely thoracic. The temperature of the body rises 
slowly to 104° and over, this effect being due to heat retention com- 
bined with direct absorption. It occurs rapidly, often within six min- 
utes, but it returns to normal in half an hour after the bath. The 
arteries become relaxed, the temporal artery assumes a dendritic form, 
as in arterio-sclerosis. The pulse is full ; its curve is high. Prolonged 
stay in the bath produces vertigo and nausea. The consumption of 
albuminoids is not increased by the hot bath. On leaving the bath 
abundant perspiration ensues. The Japanese apply cold affusions be- 
fore leaving the bath. Many suppose that colds are easily taken after 
hot baths. According to Baelz, this is impossible. While a warm 
bath relaxes the vasoconstrictors, and thus predisposes to cold, the 
very hot bath produces a paralysis of the cutaneous vessels, which 
lasts some time and prevents their contraction when exposed to cold ; 
the Japanese often run naked on the streets after their hot baths 
without taking cold. Such a bath produces no tenderness and debil- 
ity, but seems to stimulate and tone; but there is usually a slight loss 
of weight after continuous use. The sense of warmth produced by 
the Japanese hot baths is claimed to be so enduring that it is regarded 
as an economical method of keeping the body warm in winter in dwell- 
ings which are not heated. The baths at Kusatu are natural thermal 
waters of a temperature of 123° F., and are much sought by the Jap- 
anese. In these natural thermal baths the temperature usually ranges 
between 119° and 123° for the bather. 

Upon removal from the very hot bath the skin continues to re- 
main red for quite a time, depending somewhat upon the individual 
and his peculiar reaction. From the hot bath a partial atonic reaction 
takes place, followed by sweating, which, if desired, can be enhanced 
by a dry pack, retaining, as it does, the heat on the surface. The 
pulse remains quickened, and with the cooling process gradually re- 
turns to the normal. As stated above, there is a popular theory that 
persons are liable to cold after a very hot bath. This is untrue, for 
the blood-vessels remain dilated for quite a while and do not react to 
cold. As we shall see, this is not the case with the warm and tepid 
bath. 

Therapeutics of the Hot Full Bath. — These baths have obtained 
a world-wide reputation in muscular and chronic rheumatism. They 
are the ones mostly employed at saline and sulphur thermal springs, 
and have given these springs some renown in such cases. 

The daily use of the very hot full bath at 106° to 110° F. for 
ten minutes, together with rubbing and manipulation of the affected 
parts during the bath, is the method most frequently employed. In 
acute alcoholic delirium (delirium tremens), in infantile and other 



THE TECHNIQUE OF HYDROTHERAPY. 153 

convulsions, in cerebro-spinal meningitis, they have been employed 
with success. In acute nephritis and dropsy, especially the nephritis 
of the acute infectious diseases (scarlet fever, measles, diphtheria, 
etc.), it will be found capable of major service. In the acute nephritis 
of adults the author has abandoned its use for the safer and more 
satisfactory action of superheated hot air. Baelz found it of especial 
value in bronchial pneumonia and capillary bronchitis in children, re- 
lieving the congested lung and easing cough when the bath was given 
at 104° F. for five or ten minutes, two or three times in twenty-four 
hours. 

These baths are contraindicated in some cases of arterio-sclerosis, 
in cardiac disease, tabes, myelitis, spinal and cerebral organic disease 
and febrile states. 

The Warm Full Bath. 

This bath is. administered in an ordinary tub, which should be of 
sufficient length to permit of the patient reclinig comfortably, the 
tub being so filled as to cover the shoulders and body. The tempera- 
ture ranges from 96° to 100° F., never higher than the last-named 
figure. Should the temperatrue of the water decrease, more hot 
water may be added to keep the temperature up to the indicated de- 
gree. The bath is given as follows : The patient's head and neck 
having been first bathed in cold water, with a cold compress or ice- 
cap upon the head, steps into and reclines in the water. The temper- 
ature of the bath is such as to be pleasing and cause no discomfort. 
The duration varies with the object in view, ranging from five to thirty 
minutes. Friction is not used in the bath. Its physiological action 
is exerted principally upon the nervous system. Upon peripheral 
nerves we have the statement of Hyman, Klebs and Kollicker that 
cutaneous terminations become more succulent, and as a result are 
blunted, receiving and transmitting fewer impressions, for if a nerve 
is laid in warm water for a short time it becomes somewhat less irritable 
than when a nerve is exposed to the air, while protected from desic- 
cation by evaporation. Upon the brain and cord it has been showa 
by Max Schuller to cause a contraction of the pia matral blood- 
vessels, which was sustained for a long time. As a result, the brain 
sank in the rabbits he trephined, but after a return to normal condi- 
tions the animal's brain showed a much increased pial circulation. 
This is borne out by experience, and the writer has time and again, 
tested the same clinically upon his own person, the bath producing 
drowsiness and sedation. Its well-known action in irritable and con- 
vulsive states needs only to be recalled to accentuate this fact. The 
cutaneous blood-vessels are neither dilated, as in the very hot bath, 
nor is there the tonic reaction following cold measures, so extra pre- 
cautions must be taken to avoid "taking cold." The atonic reaction! 



154 PRACTICAL HYDROTHERAPY 

following the bath is usually accompanied by increased perspiration, 
the evaporation of which will chill the patient ; for that reason the 
room should be of a proper temperature, the patient quickly but thor- 
oughly dried, protected from draughts and allowed to stir around as 
little as possible. When the skin has been well dried, place between 
cotton sheets, carefully cover, putting a hot-water bottle to the feet. The 
hair must be thoroughly dried, and, if necessary, a dry turban placed 
around the head, made by folding a towel as previously described. 

Therapeutics of the Warm Full Bath. — The warm bath has been 
used to allay restlessness and reduce pyrexia. 

"Eroess reports the results of his observations upon the use of 
antipyrine, quinine, and warm baths in the pyrexia of very young in- 
fants. Among 431 cases of fever during the first ten days after birth, 
145 were of short duration, the remainder continuing for several 
days; in 184 it was continuous, and in most of the others irregular. 
In 44 per cent, it was attributable to gastro-intestinal disorders, in 34 
per cent, to some disorder connected with the navel. Antipyrine was 
given in doses of from one grain to two and one-fourth grains, re- 
peated, if necessary, in an hour. The effect was good, as was that of 
quinine. Better results were obtained from warm baths than from 
either drug. The temperature of the baths was 98° ; duration, ten 
minutes ; in weakly children, five minutes. Upon the general condition 
the result was very satisfactory. Sleeplessness and irritability usually 
disappeared, and the child fell into a quiet sleep, from which he awoke 
apparently improved. When the temperature is very high, a warm 
bath is an agent of the greatest value. 

"Wollisch reports seven severe cases of cerebro-spinal meningitis. 
The entire course of the disease was rendered mild by these baths. 
The favorable influence on the heart and nervous system was well 
marked. The baths were administered in a somewhat different man- 
ner from Aufrecht's method. The patient was put into a bath of 
the temperature of 90°, and gradually hot water was added until the 
temperature of the water reached 102°. During the bath the ice-bag 
or Leiter's coil was applied to the head. 

"The transportation from the bed to the bath should be conducted 
most carefully and as quickly as possible. If a great deal of pain is 
present in the spine, the patient must be lifted out of the bed by 
means of the sheet on which he lies, and with it lowered into the bath. 
The head should not be touched during transportation. After the 
bath the patient is wrapped in a woolen blanket and has a light cover 
thrown over him ; no drying or rubbing of the body is to be attempted. 
In this envelopment the patient is to remain an hour, when he may 
be removed. The time of day for the bath is unimportant, but the 
very early morning hours or late evening hours should not be selected." 
( Baruch. ) 

The warm full bath has been used for diagnostic purposes. Strieker 1 
says it permits the abdominal organs to be palpated, and may be used 
in place of an anesthetic. He has diagnosticated displacements and 
adhesions of the abdominal organs ; atrophy and enlargement of the 

1 Centralblatt f. Innere Medizin. March 5, 1904. 



THE TECHNIQUE OF HYDROTHERAPY. 155 

liver, spleen and kidney; calculi in the gall-bladder and renal pelvis; 
exudates and tumors which could be felt vaguely or not at all by the 
ordinary methods of palpation. 

From personal observations the author has seen good results from 
these baths in the various forms of meningitis, and in recent literature 
cases have been reported in which they proved of service. 

In various functional and nutritional nervous disorders, in insom- 
nia, irritabilty and nervousness, the author prefers the neutral bath, 
to be described later. 

The Cleansing Bath. 

As a natural corollary to its therapeutic action, we next take up the 
full warm bath as a cleansing agent. The ordinary tub is filled with 
water at 96° to 100° F. and the body immersed. The skin having 
become softened by contact with the warm water, is then thoroughly 
soaped, rubbed with the hand or flesh-brush and the lather then 
removed. After the skin is thoroughly cleansed it is dried, preferably 
with a coarse Turkish towel. The aim of this bath is cleanliness; it 
softens the epithelium and debris upon the surface, rendering them 
better suited to removal. The alkali (soap) aids in saponifying the 
greasy elements as well as softening and dissolving the epithelium or 
scales. It goes without saying that a brush, by its mechanical action, 
quickly removes the various excreta. A cleansing bath should be 
taken at least three times zveckly m cold weather and every day in 
summer, though in summer the use of soap is hardly necessary each 
day. The value of the cleansing bath lies in its removal from the 
surface of various foreign impurities, preventing the clogging up of 
the mouths of the various glandular ducts or "pores" that open their 
millions of mouths upon the skin. It will be recalled that, in speaking 
of the skin in an earlier chapter, its physiologic action was that of an 
excretory organ, and for this as well as for esthetic considerations of 
those around us the skin should be kept clean. In winter, when baths 
are less frequently taken, the use of the flesh-brush between baths 
will aid in preventing accumulations of cuticle and dirt. 

The bather is left open to the danger of "catching cold." This can 
be easily averted by the use of the shower ordinarily found in private 
homes. The cold shower causes a reaction, the bath being thereby 
more beneficial and colds prevented. The very young, the very old, 
and the sick do not stand cold water well, as a rule, but there are few, 
indeed, that cannot be educated to react and derive benefit therefrom. 

In this connection a word might be profitably said with regard 
to the 

Bathing of the Infant. 

It may be taken as a general rule that young infants and children 
are coddled as regards cold water, and this is especially true with 



156 PRACTICAL HYDROTHERAPY. 

regard to girls. No newly-born baby is to be plunged into a cold water 
bath, but by gradually diminishing the temperature they can soon be 
taught to stand reduced temperatures. In summer, when they are 
suffering from all that babies have to endure, especially in a large city, 
their resistive power and vitality can be greatly increased by bathing 
or sponging them several times daily with cold water. It has a valuable 
effect in reducing the diarrheal influence of summer. By bathing, by 
keeping them out of doors, clothed in little cotton garments, as nearly 
savage as possible, babies and little children will be spared many hours 
of suffering, mothers weeks and sometimes years of anxiety, for some 
diseases, starting in infancy, cling to maturity or even unto the grave 
itself. 

The Neutral Bath. 

The neutral, or indifferent, is a full bath, and is administered in 
the same manner as the preceding forms of application of this 
measure — that is to say, with an ordinary tub of sufficient length to 
permit of the patient's reclining comfortably with the shoulders and 
body well covered with water. The author believes that the term 
neutral more nearly describes this bath than any other, as it literally 
occupies the peculiarly unique position of being "a neutral" between 
the extremes of hot and cold. The temperature of the bath ranges 
between 91° and 96° F., and should never be administered higher 
than the last-named figure. As its duration is usually over lengthy 
periods of time, it is essential that more hot water be added should 
the temperature fall below the indicated figure. The bath is admin- 
istered as follows : The tub having been filled to sufficient depth and 
the proper temperature secured, the patient steps into and reclines 
in the water. A strap, head-rest or pillow should be so arranged as 
to enable the patient's head to be perfectly comfortable. The question 
of a cold compress to the head is one that may be left entirely to the 
patient's wishes. 

The duration of the bath ranges from one-fourth to one hour, 
although, as we shall see, it may be administered continuously for 
weeks or even months' at a time. No friction is used, all mechanical 
effects being avoided before, during and after the bath, for its object 
is sedative, and therefore any measure that possesses stimulating effects 
should be omitted. 

Physiological Action of the Neutral Bath. — The physiological 
action of the neutral bath is almost entirely limited to the nervous 
system, and it is for this reason that it has attained such a position 
as a calmative agent. Upon first entering the bath there is a slight 
sensation of coolness, followed by a sense of comfort. It lowers 
surface, although buccal temperature is not affected, a fact which the 
author has repeatedly and carefully tested. It produces no thermic 



TJ 



I 

H 



n 

o 

3 

3' 
c 



Cd 




THE TECHNIQUE OF HYDROTHERAPY. 157 

reaction whatever, and in this respect occupies an unique niche in 
hydrotherapeutics. Its action upon the circulation is negative, although 
the pulse-rate is moderately diminished. There is no circulatory 
reaction and should be none, as the aim is distinctly to avoid such 
reaction. Upon respiration and tissue change it is also negative. 
Upon the nervous system, however, we find the neutral bath a central 
and peripheral sedative of no mean value, and it is, in fact, the most 
purely sedative application within the whole range of hydrotherapy. 
As before stated, in the full warm bath Hyman and Krebs have shown 
that by the absorption of water the nerve terminals in the skin become 
succulent and blunted and convey fewer impressions from the surface. 
This is true; but in addition reflex irritability is much lessened. 
Enveloped and protected as the skin is by the bath of neutral tempera- 
ture, it must follow naturally that impressions from the exterior are 
mechanically shut off and an additional sedative action thereby gained. 
Others have stated that the action of the water upon the peripheral 
nerve endings was not really that of absorption from the water of the 
bath itself, but that the water of exhalation was retained within the 
skin and the nerve structures thereby became saturated with their own 
water rather than by direct absorption. The fact remains, never- 
theless, that nerve sensibility is decreased, no matter which explana- 
tion or theory is accepted. Upon the brain and spinal cord the 
neutral bath is reflexly a sedative, quieting cerebral action and in- 
ducing drowsiness. 

This is possibly assisted by the increased quantity of blood at the 
surface inducing cerebral anemia. The lessening of reflex action 
from the surface has a contributory influence in causing cerebral and 
spinal sedation. The action of the neutral bath upon elimination is 
principally shown in the urinary secretion, in which the water is 
increased and its acidity diminished. The bath is likewise open to 
the same objection as the full warm bath, in that the patients are 
liable to chill and catch cold. For that reason they should be quickly 
and promptly dried, without friction and carefully covered to prevent 
loss of heat. Unless this is done evaporation takes place from the 
surface and patients suffer evil rather than good results from its 
application. Should the hair be damp it must be carefully dried and 
if necessary covered by a turban. 

Therapeutic Application of the Neutral Bath. — It is in the domain 
of nervous diseases that the neutral bath reaches its highest degree of 
efficiency, particularly in the functional and nutritional disorders of this 
domain of medicine. Worthy of a special and separate description 
is its use in insomnia, the author having demonstrated it to be one of 
the most satisfactory and safest of physiologic hypnotics. In the 
management of habitues of morphine, chloral, cocaine and alcohol 
this bath can be applied with the confident assurance of immediate 



158 PRACTICAL HYDROTHERAPY. 

temporary and eventual permanent benefit. In neurasthenia and 
hysteria the writer has not found it of signal benefit as the more 
stimulating and tonic forms of hydrotherapy, but has used it especially 
for the relief of the insomnia that usually accompanies the condition. 
In cases of renal insufficiency it may be counted upon to provoke a 
free excretion from these organs. The writer has frequently sug- 
gested the use of the neutral bath at bedtime, to busy and overworked 
professional and business men who, ■ while they are not really sick, 
still need some satisfactory hypnotic to produce physiological rest 
and sleep. In pruritus this bath relieves, especially those that have 
their origin in the more purely nervous and vasomotor conditions of 
the skin. The author recalls an interesting case of this character in 
a physician who was under his care several years ago and who 
obtained immediate relief from the neutral bath. In the painful states 
that accompany neuritis, both simple and multiple, much relief and 
comfort may be obtained by the use of this bath, as it shuts out 
peripheral irritation and in that way lessens pain and suffering. This 
bath is especially suited for private practice, if patients were only 
willing to undertake and carefully carry out the physician's in- 
structions. 

In conclusion, it might be stated that it is well to use during the 
day time stimulating hydrotherapy and thus avoid any debilitating 
influence that might arise from the bath. 

One of the most lasting impressions the writer ever received 
during his European sojourn, was the influence of the neutral bath 
as applied to the treatment of mental disease. This was observed in 
its use in Bethlem Hospital, London ; maniacal cases became calm 
and quiet by an hour's sojourn in the bath, and in this hospital, as well 
as in several on the continent, the method has been employed with 
much success. 

In this connection we should consider 

The Continuous Bath, 

which is nothing more or less than the neutral bath continued for 
hours, days, weeks or even months at a time. This bath is in the 
author's experience rarely employed in America, but is used quite a 
good deal in certain places upon the continent of Europe. The 
method of its application is somewhat different, in that a larger bath 
tub must be provided, with a set of hooks or buttons along the outside, 
by means of which a sheet can be secured with strings or tapes. The 
object of this is to suspend the sheet, with the patient upon it, within 
the tub, yet completely immersed in the water. The sheet should be 
so arranged that it will not touch the bottom of the tub, but will 
suspend the patient entirely in the water, similar to the position 
assumed by one lying in a hammock, although this is not absolutely 



r 
> 

M 

00 

CO 

I 

H 



n 

o 







THE TECHNIQUE OF HYDROTHERAPY. 159 

necessary. The patient must be comfortable if the tub is to become 
his habitation for many hours or weeks. A rubber air pillow should 
be adjusted beneath his head. Arrangements must be made for main- 
taining a continuous neutral temperature, and the most satisfactory 
way in which this can be accomplished is to have the "mixed" faucet 
of hot and cold water entering at one end and an outlet at the other. 
It is essential that the water be protected from the atmosphere and 
all drafts. This is easily secured by fitting wide supporters across 
the top of the tub and covering them with blankets. It is necessary 
to remove the patient for the purpose of urination and defecation. 

This bath is usually applied both day and night, and for that 
reason as well as watching the temperature of the water a nurse is 
required to be in constant attendance. Unless care is exercised the 
skin will peel and pucker under prolonged immersion, but this can be 
obviated by the use of mutton suet or some other oleaginous prepa- 
ration. 

Baruch 2 says : "To Reiss, who studied this unique bath method 
thoroughly in a large number of cases from 1874 to 1876, we owe all 
that is known of its application for the treatment of internal diseases. 
The physiological effects upon the organism which may be expected 
from lying in a bath of from 94° to 95° F., either continuously night 
or day, or for a number of hours, are of a negative character. There 
is neither a thermic irritation of the sensory cutaneous nerve endings, 
nor any change in the cutaneous vessels, blood pressure, cardiac 
action or respiration. In every case in which Reiss applied the con- 
tinuous bath he made careful temperature, pulse and respiratory 
measurements, which demonstrated that the last two usually fluctuated 
only for a short time after the bath was entered. The most reasonable 
explanation of the effect of the continuous neutral bath is to be sought 
in the diminution or removal of those cutaneous irritations (rapidly 
changing temperatures, etc.) which are in operation in the ordinary 
contact of the body with air, and the resultant effect of this freedom 
from communicated irritating influences upon the inner organs, espe- 
cially the nervous system." The continuous bath is useful in serious 
disturbances of the central nervous system, especially of the spinal 
cord. In those conditions of paraplegia of the lower extremities, 
paralysis of the bladder and intestines occurring in locomotor ataxia, 
myelitis, and similar diseases, it is especially useful. Despite the 
greatest care, bedsores occur and progress to serious proportions in 
these cases, compelling resort to the continuous bath, which has 
proved to be the most effective remedy for this serious, discom- 
forting and painful trouble. It was through his treatment of bed- 
sores that Reiss obtained surprising results in the improvement and 
retrocession of organic nervous diseases, such as spinal pains, eccentric 

2 Ibidem. 



160 PRACTICAL HYDROTHERAPY. 

pains in the extremities and contractures which often rendered any 
position in bed painful and caused reflex spasms and similar mani- 
festations. 

Prolonged submersion in water of neutral temperature exercises 
a calming effect upon the irritability of the brain and offers a basis 
for favorably influencing those diseases of the nervous system, in 
which therapeutic efforts are usually so fruitless. "In about one-half 
of the cases of spinal and cerebral organic disease, which exceeded 
one hundred and which were subjected to these baths for several 
weeks, the improvement, not only of the symptoms, but in the disease 
itself, was undeniable. The motor and sensory paralysis, ataxia and 
related symptoms receded under the baths, although they had been 
but slightly influenced or remained unaffected under the use of other 
therapeutic measures which had been applied during many preceding 
months." (Reiss.) 

During the author's sojourn in Vienna he had the pleasure of 
seeing some of the work at Prof. Hebra's clinic with the continuous 
bath for extensive burns and some very chronic conditions of skin 
trouble. The results obtained were satisfactory, and the author be- 
lieves this bath should be much more often used than it is. 

All are familiar, doubtless, with the interesting accounts of the 
continuous bath as administered at Leukerbad, Switzerland, in which 
the patients remain immersed for weeks at a time in a large pool. 
Those that are capable of moving about play cards, eat their meals 
upon floating tables, and in other ways relieve the tedium of their 
confinement in the water. 

The Nauheim or Effervescent Bath. 

The Nauheim, effervescent, or carbon dioxide bath has become 
one of the fully recognized procedures of hydrotherapy, and is most 
efficient in the treatment of certain diseases, especially those of the 
heart. With these baths the names of the Drs. Schott will be indel- 
ibly associated, for it was through their unceasing scientific labors 
that the baths of Nauheim gained their reputation and produced such 
excellent results. It is interesting to note the wide liberality and 
breadth of mind found in the announcement of Drs. Schott, 3 who 
have insisted that the artificial baths possess similar if not nearly 
identical effects, provided that they are so prepared as to resemble 
the natural Nauheim baths in their principal ingredients, and that 
by varying the quantity of saline used and the amount of efferves- 
cence graduated, results can be obtained practically identical to those 
of the natural waters of this famed spa. It will therefore be seen 
that the discovery was not of a unique water, but of a method and 
principle of hydriatic application. 

3 See Diseases of the Heart. 



T3 



I 
H 

EJ* 
re 

n * 

o 

3 

5' 
c 
o 

IS 
01 

W 
pi 




THE TECHNIQUE OF HYDROTHERAPY. 161 

For this bath, the usual porcelain-lined or wooden tub may be 
used, of sufficient length to permit the patient to recline comfortably. 
I prefer a tub about seven feet long and broad, so as to have ample 
room. The tub should be filled with water at a temperature of from 
90° to 94° F., it being well to commence with the neutral temperature 
of 94° F., a reduced quantity of salines and hydrochloric acid. With 
succeeding baths these latter may be increased and the temperature 
lowered. 

The simplest formula used in this country is that of — 

Sodium carbonate (Na 2 CO s ) 300 grams. 

Commercial hydrochloric acid (HC1) 300 grams. 

This to be gradually increased to 800 to 1,000 grams each of salt 
and acid. 

Another formula consists of — 

Sodium chloride 8 lbs. 

Calcium chloride 12 oz. 

Sodium bicarb 1 lb. 

Commercial hydrochloric acid \ l /i lbs. 

In preparing these baths the saline ingredients should be first dis- 
solved and then the HC1 added. To rapidly prepare the bath, invert 
the bottle below the level of the water, remove the stopper and move 
the bottle over the surface of the bath, so as to distribute the acid 
evenly. over the surface and secure uniform effervescence. 

"Hydrochloric acid may be dispensed with by employing the sub- 
stances indicated in the subjoined formula. The powders are dis- 
solved in the water in an ordinary full bath. No harm is done to 
tin-lined copper tubs. 

"formula for one powder. 

"Sodium carb. (sal soda) i}/2 lbs. 

Calcium chloride 3 lbs. 

Sodium bicarb .... J4 lb. 

Sodium chloride 2 lbs. 

Sodium bisulphate 1 lb. 

"Mix and dissolve the first four ingredients ; then add slowly the 
sodium bisulphate, which should be kept by itself. It is not desirable 
to produce very marked effervescence, but rather to secure the sat- 
uration of the water of the bath with C0 2 ." 

"The carbonic acid gas is produced by this formula very slowly, so 
that it is nearly all absorbed by the water, thus making the method 
an economical one. 

"It should be remembered that it is the C0 2 dissolved in the water, 
and not that which escapes by effervescence, that produces the de- 
sired effect upon the skin. Generally the bath should be taken two 
or three days in succession each week, then one day's respite be al- 
lowed. With persons in good strength, four or five successive baths 
may be given." (Kell ogg.) 

4 Each bath costs about eighty cents. 

xii 



162 PRACTICAL HYDROTHERAPY. 

Some idea as to how these baths may be graded from weak to 
strong may be gained from the schedule below. Each bath consists 
of forty gallons of water : 

Bath No. 1 — Temperature 94° F., duration 5 minutes, sodium 
chloride 4 lbs., calcium chloride 6 oz. 

Bath No. 2 — Temperature 92° F., duration 6 minutes, sodium chlo- 
ride 5 lbs., calcium chloride 8 oz. 

Bath No. 3 — Temperature 90° F., duration 7 minutes, sodium chlo- 
ride 6 lbs., calcium chloride 10 oz., sodium bicarbonate 8 oz., HC1 7 oz. 

Bath No. 4 — Temperature 88° F., duration 8 minutes, sodium chlo- 
ride 6 lbs., calcium chloride 10 oz., sodium bicarbonate 8 oz., HC1 7 oz. 

Bath Xo. 5 — Temperature 88° F., duration 8 minutes, sodium chlo- 
ride 7 lbs., calcium chloride 10 oz., sodium bicarbonate 8 oz., HC1 10 oz. 

Bath No. 6 — Temperature 87° F., duration 10 minutes, sodium chlo- 
ride 7 lbs., calcium chloride 10 oz., sodium bicarbonate 8 oz., HC1 10 oz. 

Bath No. 7 — Temperature 87° F., duration 10 minutes, sodium chlo- 
ride 8 lbs., calcium chloride 11 oz., sodium bicarbonate 12 oz., HC1 
14 oz. 

Bath No. 8 — Temperature 85° F., duration 12 minutes, sodium chlo- 
ride 8 lbs., calcium chloride 11 oz., sodium bicarbonate 12 oz., HC1 
14 oz. 

Bath No. 9 — Temperature 85° F., duration 12 minutes, sodium 
chloride 10 lbs., calcium chloride 12 oz., sodium bicarbonate 1 lb., 
HC1 1 lb. 

Bath No. 10 — Temperature 85° F., duration IS minutes, sodium 
chloride 10 lbs., calcium chloride 12 oz., sodium bicarbonate 1 lb., 
HC1 1 lb. 

Baths Nos. 11-20. — Temperature 83 F., duration 15 minutes, 
sodium chloride 10 lbs., calcium chloride 12 oz., sodium bicarbonate 
1 lb., HC1 V/ 2 lbs. 

Another method that may be employed is that of the "Triton 
Salts," as follows: Fifty gallons of water to which is added five 
pounds of common or sea salt and the contents of the bag of sodium 
bicarbonate. The bottom of the tub is then covered with rubber 
sheeting. On this rubber sheeting place the eight acid cakes from 
the box of Triton salts so that two shall be at the back, two on each 
side of the body, and two under the knees. The bath is now complete. 
In about three minutes, when effervescence is well under way, the pa- 
tient should lie down in the bath and rest quietly without unnecessary 
movement. The temperature and duration must be graduated. It 
can be regulated by using more salt, up to fifteen pounds, and fewer 
number of acid cakes, during the first few baths. The author does 
not believe in the use of carbon dioxide gas ; the tanks and apparatus 
are cumbersome; it is more expensive (with me) and the evolution 
of gas is too rapid. 




Plate 89— Continuous Bath, or Bathing at Leukebad, Switzerland. 



THE TECHNIQUE OF HYDROTHERAPY. 163 

The duration of these baths should be carefully graded to meet 
the patient's strength and requirements. For an average case eight 
minutes' duration, gradually increased to fifteen minutes, is a good 
rule, remembering that the time of the previous bath should not be 
lengthened when the acid or saline constituents are increased, but a 
bath should intervene. Twenty or thirty baths usually constitute "a 
course," a day being allowed to intervene after every third or fourth 
bath. The saline and acid is begun weak, the temperature high 
(94° F.), the duration short (five minutes). Increase the quantity 
of the constituents and carbonic acid gas gradually and reduce the 
temperature (94°) two degrees daily to 83° F., or even lower. The 
patient reclines quietly in the tub. He must not talk. When the time 
elapses he is assisted from the tub and rubbed dry with a warm tozvel, 
avoiding exertion or exposure. It is best to remain quiet, or, better, 
recline for one hour after the bath. Where there are infiltrations or 
deposits in the system local massage may be applied to them after 
the bath. The pulse should be counted, percussion and auscultation 
performed, notes and diagrams made both before and after the 
bath. 

Schott 5 calls attention to the fact that the chloride of sodium and 
calcium are the salts most active in the waters of Nauheim. For 
cardiac disease the baths are given in conjunction with graduated 
resistive exercises. It should be noted that the Nauheim bath is 
a saline, carbonic acid gas, neutral bath, in the great majority of 
instances, immersion in which produces a transient chilliness, ac- 
companied by a sensation of oppression of the precordia and res- 
piration, lasting but a moment. As this passes away the respira- 
tions become slower, fuller and deeper, the reduction amounting 
in ordinary cases from two to four per minute, unless the respiration 
is very rapid, when they are correspondingly reduced. As the res- 
piration quiets the lung capacity is increased and the exchange of 
O and CO, favored. The thermic influence is small, and temperature 
is little affected, compensation being rapid. After immersion minute 
bubbles of carbon dioxide collect upon the surface of the skin, and 
recur immediately when brushed off. These bubbles, in the presence 
of a saline medium, affect profoundly the superficial nerves, resulting 
in marked vasomotor effects, by which the cutaneous circulation is 
stimulated, the blood-vessels dilating and the column of blood thereby 
being directed to the periphery. This flooding of the skin "lifts the 
load" from the heart, sucks the blood from the congested viscera of 
thorax and abdomen, thereby better "equalizing" the distribution and 
movement of this fluid. In normal individuals I have observed a fall 
of ten and even fifteen beats, while very rapid pulses may be reduced 



5 Schott, A.: Blaetter f. Klinische Hytlrotherapie, 1 880 ; Schott, Theo. : Medical Record, 
March 11, 1899, p. 345; Medical Record, March 26, 1898. 



164 PRACTICAL HYDROTHERAPY. 

thirty to forty beats by a single bath, meaning reduced cardiac labor. 
This surface effect — that is, lessened peripheral resistance and firmer 
cardiac action — is a response that resembles the action of digitalis 
and nitroglycerine, without their drawbacks. The heart is directly 
affected. If it is auscultated and the pulse studied before, during and 
after the bath, it is found that the heart beats slower and stronger; 
the rhythm becomes regular, and the sounds clear. Systole and 
diastole are both prolonged, the arteries dilated. The pulse grows 
full, increases in force, and the blood pressure rises to the extent of 
20 or 30 mm., denoting a greater quantity of blood in the arterial 
system. The vertical sphygmograph lines are higher and the hori- 
zontal ones wider, indicating a longer time for the passage of blood 
from aorta to capillaries. If these conditions are carefully studied 
it will be readily seen that there is a beneficial stimulation to the 
heart which must augment its tone and improve innervation of the 
cardiac muscle. The enlarged and feeble heart is contracted often 
20 per cent, during a single bath (see cut). One has to see these 
results to be willing to accept such a seemingly improbable statement. 
This reduction of area, as shown by percussion, is accompanied by 
marked increase of cardiac power, with lessened resistance to heart 
action. In old cases of valvular lesions the increased rest afforded 
the heart muscle enables it to feed, regenerate, hypertrophy and thus 
compensate its lesions, a result that is curative, and that cannot be 
obtained by drugs. With the resistance to the flow of blood de- 
creased, a weak or dilated heart muscle contracting fully compensates, 
following the physical law that a muscle that works naturally in- 
creases its tissue and strength, consequently hypertrophies. Another 
beneficial effect of the dilatation of the peripheral arteries is the 
reduction of intracardiac pressure, a no mean factor in promoting 
the contraction of a dilated heart. A fortunate feature of the bath 
is its eliminating action upon rheumatic toxins, because of the frequent 
association of rheumatism as a cause and concomitant of heart disease. 
Heart sounds are rendered clearer and abnormal sounds, which were 
not noticeable before the bath, are plainly brought out, and ausculta- 
tion more clearly reveals the real condition of the organ. The in- 
creased metabolism that follows these baths is due to better elimina- 
tion and circulation, for with the relief of the congestion existing 
the metabolic and cellular processes of the body take on renewed 
functional activity, this being especially true of the abdominal and 
pelvic organs. In view of this it is not surprising that the kidneys 
begin to act more freely and continue to do so for a long time after 
the baths are discontinued. The peripheral nerves are promptly 
affected by these baths, transmitting the impressions made by the 
thermic stimuli (where the bath is below 92° F.), the saline medium 
and CO,, gas, from the surface, through the spinal cord to cerebral 




evCo^^-"»-^>^ 



Mr 







Jj^-o-kXK^jp^Ax . 



Plate 90 — Diagram of Cardiac Area of Dullness Before and After 

Nauheim Bath. 



THE TECHNIQUE OF HYDROTHERAPY. 165 

centers associated with the vasomotor and cardiac apparatus, and 
from them through the pneumogastric to the cardiac ganglia, and 
from the vasomotor centers peripherally to the cutaneous and associ- 
ated vascular trunks. Upon nerve tissue it is stimulant to renewed 
activity, producing tone and exhilaration, and in those neurasthenic 
cases complicated with cardiac trouble, changes remarkable to behold 
follow its use. 

It will thus be seen that the Nauheim bath acts upon the smaller 
blood-vessels and capillaries of the surface; that they are dilated; 
that ventricular contraction is relieved; causes a slowed pulse and 
completely emptied heart; toned capillaries and greater volume of 
distal circulation ; better neuro-cardiac action ; increased action pf 
skin and kidneys; trophic and other nerve influences. 

Therapeutics of the Nauheim Bath. — The greatest usefulness of 
this bath lies in the domain of cardiac and vascular disease, for it 
possesses all the value of hot and cold baths without the disadvantage 
of the extremes of temperature, in the one instance (hot) preventing 
harmful excitement and in the other (cold) avoiding the increased 
work placed upon the heart itself. It should be distinctly borne in 
mind, however, that the Nauheim bath in the treatment of heart dis- 
ease is but a part of a system of baths and graduated exercises, and 
that these latter play a most prominent part. In cardiac disease the 
patient must not be exhausted, and if weak should be rubbed during 
the bath. It has an extended field of action in some of the most 
intractable diseases with which practitioners have to contend, such 
as endocarditis, valvular insufficiency, arterial and cardiac stenosis, 
cardiac dilation, Basedow's disease, all forms of motor and sensory 
cardiac neuroses, and finds a contraindication only in conditions in 
which an increased arterial pressure would be dangerous, such as 
pronounced arterio-sclerosis, aneurism, fatty degeneration and angina 
pectoris accompanied with sclerosis of the coronary arteries. In those 
cases of chronic so-called rheumatic or articular disease favorable 
results have been obtained from the use of these baths. The author 
does not recommend them in rheumatic diseases, unless they are 
complicated by organic heart disease. Sometimes the gouty and 
rheumatic suffer from a recrudescence, but this is usually of short 
duration. Those afflicted with chronic pelvic disease of a congestive 
or inflammatory type receive marked benefit from the derivative and 
metabolic influences produced by this bath. In locomotor ataxia I can 
confirm the praise that many writers give to this bath; it is certainly 
of value. It may be used as a half or full bath, and during its use the 
limbs may be rubbed. The bath is contraindicated in acute and sub- 
acute inflammatory diseases of the spinal cord. 



166 PRACTICAL HYDROTHERAPY 

Oxygen Bath. 

Winternitz 6 has recently studied the action of oxygen instead of 
carbon dioxide baths. It is an effervescent bath, the action of 
which is not due to any oxygen absorption, but to the physical and 
chemical irritation of the presence of oxygen in the water, in the 
same manner as the carbon dioxide bath. The oxygen bubbles are 
smaller, adhere closer to the surface in a layer between the skin and 
water. They cause a pleasant prickly sensation, and alter the thermic 
impressions arising from the surface. The temperatures are the same 
as the Xauheim bath. Baths given at 86° F. decreased blood pressure 
35 mm. Hg. while in the bath, and twenty minutes after the bath a 
further drop of 58 mm. took place. At 97° F. the pressure was low- 
ered 25 mm., but before the end of a ten minute bath was 10 mm. 
above pressure at beginning. In a C0 2 bath at 86° F. the pressure 
was reduced 35 mm., but during the bath began to rise, and one hour 
later was only 10 mm. lower than before. Fresh water lowered 
pressure 20 mm. during and increased slightly in half an hour 
later. The best temperature, therefore, to reduce blood-pressure is 
86° F The relative frequency of the pulse was studied. At 68° F. 
the pulse was reduced by fresh water, 18; by 0„, 12; by C0 2 , 12; 
at 97° F. fresh water reduced 8; 2 , 8; C0 2 2 beats. Temperature 
supplemented by the mechanical and chemical action of the gas is 
most important in affecting blood pressure. Oxygen bubbles cause 
goose flesh, owing to the rhythmical contraction of the cutaneous 
muscles. This increases "Hutchinson's peripheral heart." It finds its 
sphere of usefulness in high blood pressure, cardiac neuroses, neuras- 
thenia and cases sensitive to low temperatures. Low blood pressure 
contraindicates. 

The Full Cold Bath. 

This is one of the most powerful of all hydriatic procedures, its 
use being practically limited to acute infectious diseases. It is known 
in this country as the Brand bath or "tubbing," acquiring its name 
from its originator, Dr. Ernest Brand, of Stettin, Germany. When 
used by those in health or in certain non-infectious diseases its action, 
aim and object are entirely different from the action of the bath in 
infectious diseases, and are described under the head of the "plunge 
bath." The tub to be preferred is a tin one capable of being moved 
to the patient's bedside. It should be at least six and a half feet long 
by two and a quarter feet wide. It may be here remarked that tubbing 
can be carried out in the country as well as in the city, the parapher- 
nalia needed being simple and easily obtained. Where the slightest 
ingenuity is exerted the object can easily be attained. 

In hospital practice one of the tubs here illustrated will be found 

6 Winternitz, Wm.: Blaetter f. Klinische Hydrotherapie, January, 1907. 




Typhoid Fever Tub (Bellamy's"). 




Presbyterian Hospital Tub (Oliver's). 




Pi.ati 91 — Portable Path Tubs. 



THE TECHNIQUE OF HYDROTHERAPY. 167 

more useful, because of their superior durability and the ease of 
cleaning them. The shape of the tub is well shown in the diagram. 
It is fifty inches long and twenty-seven inches wide, and consists of 
two parts, so arranged that the patient's lower extremities are bent 
at right angles to his recumbent body, the feet resting upon a double 
bottom which is filled with hot water. The latter is poured into the 
douche bottom through a tube with a funnel-shaped opening, which 
is secured in one corner of the tub ; a faucet upon the posterior aspect 
of this hot-water receptacle gives exit to the hot water. The object 
of this tub is to afford the patient an easy recumbent position and 
prevent the cold water from chilling the feet and producing painful 
cramps during the bath. Its short and compact form renders it more 
portable than the ordinary tub. The manufacturers 7 have con- 
structed the bath-tub of highly enameled wood and lined it with 
tinned copper, thus rendering it easily cleaned. The height of the 
tub saves much back strain to the nurses, whose constant attention 
is required for friction during the continuance of the bath. Among 
the best portable tubs is the Coile. 8 It is a safe and efficient means of 
administering the Brand bath, especially in bed. It is more easily 
managed in private homes and is less feared by patients. It is a full- 
sized pneumatic tub, that may be inflated by introducing air with an 
ordinary air pump, and deflated by opening the air-escape valve. It 
is made of rubber fabric. On a level with the bottom is a funnel 
sleeve through which water may be poured into or removed from the 
tub. The entire outfit — tub, pump, towels, etc. — may be packed for 
transportation in an ordinary suit case 13x26 inches. A blanket is 
first spread on the bed and the tub placed on top of it. The patient is 
then assisted by the nurse, who first gently lifts the head and 
shoulders, then the hips and legs onto the deflated tub (see cut), the 
walls of which are then inflated by the air pump, requiring but a 
minute. The water at proper temperature is then poured in and the 
process hereafter to be described carried out (see cut). When com- 
pleted the nurse lowers the funnel sleeve into a suitable vessel on the 
floor by the bedside and the water quickly flows out. At the same 
time the air is allowed to escape from the valve, allowing the tub to 
collapse. The patient is now removed from the tub upon the blanket 
(see cut). 

Ordinarily after the tub has been secured a piece of oil cloth, 
carpet or other protective of sufficient size is placed on the floor by 
the bedside in order to protect the floor or carpet. The tub, with 
its head at the foot of the patient's bed, is then placed on two low 
stools or wooden rests so as to bring its rim on a level with the 
patient's bed. It should be separated from the patient's bed by a 

7 Kny-Scheerer Co., 224 Fourth Avenue, New York City. 

8 Coile Bed Bath Co., Knoxville, Tenn. 



168 PRACTICAL HYDROTHERAPY. 

screen. Several towels, a sheet, and a napkin should be at hand. 
The tub is now filled with water to a depth sufficient to cover the 
patient, at a temperature ranging from 85° to 65° F. Where possible 
the tub should be partly filled with water outside the patient's room, 
the correct temperature being secured by the addition at the bedside 
of water either hot or cold. Every effort is made to make as little 
disturbance as possible and all excitement must be promptly elimin- 
ated. A double blanket is spread on the bed to be occupied by the 
patient; over this is placed a dry and soft linen sheet and the pillow 
or bolster covered with a crash towel. Everything being in readiness, 
the patient receives a stimulant. This one point of a stimulant is 
much opposed by some who use the full Brand bath ; the author be- 
lieves in its use only in emergencies. The night dress or night gar- 
ments are removed and the sexual organs protected by a napkin. The 
face is now bathed in cold water ( 50° F. ) , and a cold wet turban 
placed on the head. There should be no evidence of faint-heartedness 
or lack of confidence in the application of this bath by the nurse or 
physician, should he be a bystander, and it is a good rule for the phy- 
sician to always be present at the first bath. All members of the fam- 
ily must, if possible, be excluded from the room. The patient is now 
gently lifted from the bed and placed in the bath. The first impres- 
sion is exceedingly disagreeable, and he is apt to gasp and shrink from 
its further use. He must be encouraged and reassured both by word 
and action, for an entire absence of haste and fussiness will do much 
to overcome his very acute desire to be let off from what he will 
term severe treatment. Here, as in many of the positions in which 
a physician is placed, tact will accomplish wonders. My observa- 
tion, however, leads me to believe that the family are, as a rule, 
more difficult to manage than the patient, as they are usually strangers 
to cold water in their daily ablutions, and share with the patient the 
feeling of repulsion. As soon as the patient is immersed, the nurses 
commence to gently rub or chafe the entire body, rubbing the different 
parts successively, but avoiding the lower abdominal region. Too 
great stress cannot be placed upon the need for this rubbing, and its 
careful and continued use during the bath is the one absolutely neces- 
sary feature to success. Brand truly states that by its use collapse, 
cyanosis and heart failure are prevented, and this is readily believed 
by those who have used the bath and seen the redness that follows 
its application. Under the influence of cold and friction there is a 
contraction and dilatation of the peripheral blood-vessels, and, as 
we shall see later, this enhances heat abstraction. No attention should 
be paid to a small pulse, to complaints of chilliness, to a shrivelled 
condition of the skin of the hands and fingers, for these do not de- 
mand cessation of the bath, but care and attention should be given to 
the face, especially the lips, and if cyanosis occurs it is due to en- 




Plate 92 — Patient in Deflated Tub. 




Platf. 93 — Inflating the Tub. 



THE TECHNIQUE OF HYDROTHERAPY. 169 

feebled heart action; for the face, being free from the local action 
of the cold water, is a true index of a cyanosis due to the lack of 
cardiac action. Should this occur, the bath must be discontinued and 
the patient removed. In the use of the next bath more attention must 
be paid to friction, for it may be taken as a good rule that where 
friction is well applied no such result is to be expected. During the 
bath the turban on the patient's head must be re-wet. The tempera- 
ture at which the bath is administered is usually 65° F., but it is a good 
plan to commence at 85° to 90° F. and reduce each bath from three 
to five degrees until 65° F is reached, at which point the temperature 
is maintained. The duration of the bath is usually fifteen minutes, 
but here again it is also a good plan to commence with five to seven 
minutes and lengthen the time as the temperature of the water is 
lowered. It must be again reiterated that friction is the element to 
watch, making it as vigorous as the patient will stand. The patient 
should not be removed during the primary reaction, as the aim in this 
bath is not to secure ordinary hydrotherapeutic reaction. The bath 
being finished, the patient, is lifted out of the tub and placed on 
the prepared bed, the napkin dropped from the pelvic region, rapidly 
covered with the dry linen sheet, the folds of which are pressed be- 
tween the arms and the body and between the lower limbs. The 
blanket is then wrapped around the body and hot-water bottles placed 
to the feet, which are usually cold. The wet turban is now removed 
from the head. The patient's hair is dried while he lies from five to 
ten minutes in the sheet and blanket. He is then to be gently dried 
with towels, the night dress put on, the blanket, sheet, etc., removed, 
and covered lightly with the bedclothing. If the bath is successful, 
the patient is quiet, comfortable and usually falls asleep. If he is 
restless, is uncomfortable and shivers, the technique is inaccurate and 
points to a change in the temperature, duration or friction, especially 
the latter. The hot-water bottle should be allowed to remain only a 
few moments, as it is unnecessary, and usually becomes needless 
after a few baths. 

Physicians and others who have been subjected to both varieties 
of baths claim that the sudden immersion into the coldest temperature 
required is far less unpleasant and chilling than the gradually reduced 
bath. The latter is certainly more fussy and troublesome. 

"The Zicmssen graduated bath belongs also in thi.s category. 
Ziemssen has the patient sit in a bath the temperature of which is 
5° or 6° C. (68° F.) in the course of ten or fifteen minutes. The 
duration of the entire bath is from twenty to thirty minutes, until the 
patient ceases to shiver in spite of vigorous frictions and af- 
fusion. He is then removed and placed in a previously warmed bed. 
The bath is far more efficacious in its antipyretic effect than the cool 
baths of short duration. There will be observed a decline in the tem- 
perature of so much as 2)/ 2 ° C. (4.5° F.), but the stimulating influ- 



170 PRACTICAL HYDROTHERAPY. 

ence upon the vascular and the nervous systems is wanting, and depres- 
sion is often more serious than even a considerable elevation of tem- 
perature." 9 

Physiological Action of the Full Cold Bath. — Before we consider 
in detail the action of the Brand bath (full cold bath with friction), 
it is well to first take up the part played by friction. As has been 
shown heretofore, its application produces a stimulation of the cu- 
taneous blood-vessels, that dilate under its use, so that a large quantity 
of blood is made to traverse the skin, which in this instance gives a 
larger radiating surface for heat abstraction and cooled blood ex- 
changed for warmer. By the prevention of tremor, muscular con- 
tractions, both tonic and clonic, are eliminated, and one of the means 
of heat compensation checked ; thus production of heat is prevented 
at the same time that the cold water abstracts greater heat; for, as 
Pospischl has shown, mechanical irritation of the skin decidedly in- 
creases heat loss, which increase he placed at as much as 95 per cent. 
With this preamble we are ready to consider its action upon circulation. 

As soon as immersed, contraction of the superficial tissues takes 
place, especially the blood-vessels, and accompanied by tremor. These 
blood-vessels would remain contracted during the entire bath were it 
not for the friction. When faithfully performed, the skin takes on a 
pinkish hue, showing that the cutaneous circulation is more active, 
and that the column of blood driven from the surface to the interior 
by the first impact of the water has returned to the periphery. As a 
resultant, the interior is drained, and the movement of the blood made 
more active as well as perfect. The pulse is slowed, its tension raised, 
and while smaller during, becomes much larger after the bath. Sphyg- 
manometric measurements show an increase in arterial tension. The 
thermic and other impressions arising in the periphery are conveyed 
to the central nervous system, and from the governing centers therein 
are reflected upon the cardiac mechanism, as a result of which toning 
and refreshing influences are brought about, which in turn stimulate 
the cardiac muscle, energizing it, increasing the force of its contractions, 
lessening their number, producing a pulse that seems small, though its 
tension is improved and it possesses increased force. Two conditions 
result — obstruction at the periphery is removed, and a vis a fronte 
encouraged, while the stronger contractions of the heart increase the 
vis a tcrgo. a favorable state of the circulation under any circum- 
stances. It should be borne in mind that these influences upon the 
pulse, heart and circulation do not immediately pass away, but grad- 
ually subside between baths. A failure to appreciate the effect of the 
constrictive action of cold upon the peripheral vessels has led many 
to find fault with the full cold bath in the treatment of febrile condi- 
tions. Again I state, friction is the keynote of success. 

9 Strasser, A. : "Hydrotherapy," Vol. IX, Cohen's Physiological Therapeutics. 







Plate 9A — Nurse Applying Frictior 




Plate 95 — Drawing Off the Water. 



THE TECHNIQUE OF HYDROTHERAPY. 171 

Upon the temperature this bath has a most noticeable and impres- 
sive effect, but one should here again interpose and state that the 
reduction of temperature is not the sole aim of the bath, as so many 
physicians imagine. Temperature and the specific typhoid germ are 
not so dangerous themselves as are generally supposed ; in fact, many 
now believe a moderate range of fever is beneficial in infectious dis- 
eases. The danger arises from two sources — the typho-toxins and 
those metabolic poisons that arise from the pathological tissue state 
incident to the disease. While the bath first causes contraction of the 
superficial tissues and tremor, associated with a transient rise in tem- 
perature, the friction overcoming this, and producing a marked dila- 
tation of the blood-vessels of the surface, we now have all the factors 
aiding in heat loss. The body being immersed in the cold medium, 
with a large area of blood exposed to its action, gives up its heat to 
the surrounding water, while heat generation is prevented by the 
elimination of tremor or muscular activity. This loss is somewhat 
proportional to the dilated state of the blood-vessels, for, as has been 
shown by Traube, a rise in temperature is usually due to a con- 
traction of the blood-vessels, and that the maximum rise of tempera- 
ture is coincident with their maximum contraction ; hence it is that the 
effect of this bath upon the circulation above described is to eliminate 
two of the principal features in the prevention of heat elimination. 
Reflexly, the contracted internal vessels prevent visceral heat gen- 
eration. The blood, after giving up its heat, is pushed by the toned 
circulation into the interior, and bathing the thermogenic centers in 
a cooler medium favors heat elimination and lessens heat generation, 
while the superheated visceral blood is driven to the surface. Reduc- 
tion of temperature follows. 

Upon the nervous system is to be found the greatest good and most 
enduring action of the full cold bath. In the majority of febrile in- 
fections, be they due to specific micro-organisms or otherwise, their 
influence becomes noticeable at once upon this important mechanism 
of the human body, and it is not long before it shows a deprecia- 
tion in tone that is doubtless due to the toxin of the specific morbific 
agent. We find that, as a rule, malaise and partial exhaustion present, 
which, when followed to the ultimate end, simply mean the fore- 
runner of coma, delirium, stupor, subsultus, etc.; sleep restless, dull 
headache, and a general hardly definable nervous unrest and discom- 
fort, very trying to most cases. Mental function is much diminished, 
the expression is apathetic ; all the ordinary nervous functions dimin- 
ish in activity. This is usually the condition of affairs when the pa- 
tient is seen with a fully developed febrile attack. All will probably 
admit that the greatest danger lies in the overwhelming of the ner- 
vous system by these poisons, and that too great care cannot be taken 
to prevent their evil effects. It has been maintained by those who are 



172 PRACTICAL HYDROTHERAPY. 

far more competent than myself to speak, that the essential point in 
the conduct of such cases is the maintenance of the patient's neural 
vitality until the poison of the affection can be eliminated. While 
this is in a certain sense true, still it is not all that is necessary. I think 
it will be found upon close investigation that the full cold bath comes 
nearer to meeting all the requirements of each observer than any other 
single therapeutic weapon that can be wielded. When we come to 
study the influence of the full cold bath upon the nervous system in 
febrile diseases, we find that all the conditions mentioned above are 
promptly met, and that its application with friction arouses into ac- 
tion all the peripheral nerve endings, impressions from which are con- 
veyed to the great centers, a thousand reflex influences started, that are 
shunted to every nook and cranny of the central nervous system, with 
the result that this mechanism is aroused from its lethargy and stim- 
ulated to throw off the dominating and paralyzing influence of the 
acute toxins. The eye no longer appears apathetic, but brighter; 
the mind clears up and responds more promptly ; reflected effects are 
shown in every function of the viscera, and varied influences travel 
to the end of every nerve fiber of this governing and dominant sys- 
tem, so that its dynamic power is aroused to fight the battle and main- 
tain its integrity. It is largely because of these effects upon the central 
nervous system that hydriatists maintain that the Brand bath, when 
properly applied, accomplishes more than any known medicinal rem- 
edy upon temperature, circulation and the nervous system. 

Upon respiration the first effect of the cold bath is to cause gasping 
and a sense of disagreeable constriction about the chest. Respira- 
tion is increased during the application of the bath itself, and is, as 
a rule, shallower than normal. Observations made upon this function 
show that in febrile diseases, as a rule, both the amount of oxygen 
inhaled and absorbed, and carbon dioxide exhaled and eliminated. 
are markedly diminished. Immediately upon the removal of the pa- 
tient from the bath, the respiration usually returns to the normal, and 
is fuller and deeper than before the application. There is a greater 
amount of absorbed oxygen and a greater amount of exhaled carbon 
dioxide, showing that this bath simply bears out the general hydro- 
therapeutic effects of cold baths properly applied, viz., that there is 
a marked increase of oxidative processes taking place in the body, 
and this we would expect, particularly in view of the circulatory 
changes. Energizing muscular tissues, as the Brand bath does, we 
find that the amplitude of respiration is enhanced, which of itself acts 
like a pump in moving the blood through the pulmonary and general 
circulation, relieving stasis and hypostatic congestion, as well as aiding 
in the better removal of mucus in the bronchioles. It is almost need- 
less to remark that a better oxygenized blood destroys toxins, specific, 
metabolic and auto-toxic. 




Plate 96 — Drying Patient. 




Plate 97 — Removing Tub. 



THE TECHNIQUE OF HYDROTHERAPY. 173 

Upon metabolism, febrile disturbances, as a rule, prove quite a dis- 
turbing factor. The entire economy is combating with a specific toxin, 
the effect of which upon the tissue is most marked, producing degen- 
eration. The glandular system of the body, especially the liver, in 
its endeavor to throw off this poison, is particularly prone to be af- 
fected, and its failure to act profoundly influences the metabolic 
processes of the body. All secretions of the glands of the gastro- 
intestinal tract are diminished in quantity and quality. As these se- 
cretions digest food and maintain intestinal activity, their absence or 
decrease means the development in the intestine of certain bacterial 
flora, the coli and putrescent ones, which add another factor to the 
already overburdened and toxic system. Within the tissues oxidative 
processes are reduced to a low level, so that toxic material of a kata- 
bolic character accumulates, being incapable of removal because of 
a weakened circulation and diminished elimination. With a more 
active circulation, with a rise in blood pressure, these toxins are pushed 
out of the liver and other tissues, glandular action is stimulated, the 
tongue clears, sordes lessens, appetite improves, digestive power is 
regained. With the respiratory activity and oxygen-absorption, oxi- 
dative processes take place, destroying the waste tissue material and 
toxins, or converting them into harmless soluble end-products capable 
of easy removal. Nutrition is of necessity enhanced, and degenera- 
tive processes prevented, especially if the bath is used from the start. 
This improved state of tissue is particularly well shown in the im- 
proved state of the skin and its glandular structures, which changes 
from its sallow, dry, harsh and inactive state, and becomes white, 
moist, elastic and soft. 

Upon elimination the action of this bath is specific. The febrile 
state causes a diminution of the action of all glandular structures that 
preside over this function, it being especially noticeable in typhoid 
in the secretion of the kidney and skin. The quantity of the urine 
steadily diminishes, and assumes its characteristic dark color, turbid 
appearance and disagreeable smell, while its toxic power rapidly rises 
until it is several times as toxic as normal urine. The first noticeable 
effect upon this excretion is an increase of volume, although little 
change in appearance takes place. Shortly, however, it more nearly 
assumes the normal, and its increased volume may be maintained, 
as much as fifty to sixty ounces being passed in twenty-four hours. 
This is due not to the increased water drinking, as some suppose, but 
to a better vasomotor tone and rise in blood pressure. The better puri- 
fication of the blood stream by the more active kidney reacts upon 
every function and tissue of the body, for just in proportion to the 
lessening of toxins will the general danger to the patient diminish. 
The skin of a febrile patient has a peculiar feeling to the touch, and 
appears dry, dirty, harsh and inactive. Its blood-vessels are con- 



1/4 PRACTICAL HYDROTHERAPY. 

tracted, large masses of epithelial cells collect on the surface, the 
glands act little and their secretion is quickly dried. Its vicarious 
function in states of toxemia has been pointed out by Bouchard, 10 but 
this is in abeyance. Immersion in the cold bath, accompanied by fric- 
tion, upon producing the vascular changes enumerated, resumes its 
activity. The softening effect of the water and the mechanical re- 
moval- of the dead epithelium and inspissated excretions give the 
glandular structures an opportunity to eliminate both bacteria and 
toxins. The skin gradually becomes softer, more pliable and elastic, 
loses its dingy, dirty appearance, becomes white and pleasant to the 
touch. As the glands act more freely a slight moisture appears, fa- 
vorable to elimination as well as to heat loss. 

Upon the blood, as we have previously shown, cold baths act bene- 
ficially. In febrile states the number of corpuscles, both red and 
white, are not only diminished, but rendered less active both in their 
oxygen-carrying and bactericidal power. Winternitz and Thayer 11 
have shown that the cold bath not only increases markedly the number 
of red blood cells in the circulation and their oxygen-absorbing and 
carrying power, but that this is true in typhoid as in health. The in- 
teresting iole that the leucocytes play in their phagocytic capacity is 
diminished or obtunded in infectious fevers, but the stimulating effect 
of the cold bath rouses them from their lethargy, increases their num- 
ber and power to battle with the invading host. The enemy are met 
and checked, even if they are not completely routed. Breitenstein 12 
found in twenty-nine cases that there was an increase of at least fifty 
thousand red cells to each cubic millimeter, which was accompanied 
by a corresponding increase of hemoglobin. 

In conclusion, it may be said that the cold full bath of Brand rouses 
the nerve centers, sustains vital power, stimulates respiration and oxi- 
dation, increases elimination, energizes the heart, improves the pulse, 
raises arterial tension, thereby toning the circulation through the vase- 
motors ; purifies the blood, reduces temperature, prevents compli- 
cations and makes the patient more comfortable. This bath should 
never be administered when the patients are very old, to infants, when 
hemorrhage is threatened, when the temperature is subnormal, in the 
eruptive fevers, pneumonia, nephritis, or inflammations of the visceral 
organs of abdomen or pelvis. 

The therapeutic action of the Brand full bath is practically limited 
to the treatment of severe febrile manifestations, of which typhoid 
fever is the type, and for the treatment of which Brand originated 
the bath. When we come to consider, in the therapeutic portion of 
this work, the question of the treatment of typhoid fever, this sub- 

10 Bouchard, C. : "Auto-toxemia.'' 

11 Loc. cit., p. 4S — 

12 Archives f. Experiment. Pathtlojie und Pharmakclceie, Ba-ul 32, 1896. 




Plate 97a— Plunge Bath. 



THE TECHNIQUE OF HYDROTHERAPY. 175 

ject will be taken up in detail, and therefore will not be mentioned 
here. 

The Cold Plunge Bath. 

This bath is usually administerd with an ordinary bath-tub of suf- 
ficient length to permit of the patient's reclining comfortably with 
the shoulders well covered by the water. The best tub, of course, 
is the porcelain-lined tub of good width and fully seven and a half 
feet long. It may also be administered in institutions in a water-tight 
tank with a depth of about five feet. It is customary in these institu- 
tions to have one end of the tank with steps so that the patient can 
either walk or plunge into the bath and walk out. The tub should be 
filled with water ranging from 50° to 65° F., the duration in brief 
ranging from one-fourth to one-half minute. The plunge bath should 
not be used save by those who are in excellent and robust health, and 
never be entered when the skin is cold or chilly. The body must be 
well warmed, either by some brief hot application, such as a warm 
bath, dry hot air, electric light bath, Turkish bath, or exercise. The 
cold plunge is often taken in the morning as a stimulant by the robust. 
The best effects are, in my opinion, derived from a very sudden immer- 
sion of great brevity. It is best to at once "plunge" into the bath, 
immersing the head, as by so doing the sensation of cold is far less 
noticeable and much less disagreeable than when slowly entered. 
Ten to fifteen seconds is ample for the average plunge, although some 
writers recommend it for a period of even two minutes. During the 
bath the patient should rub himself vigorously or use swimming 
movements. Immediately upon emerging he is wrapped in a Turkish 
sheet and vigorously rubbed until dry. It is essential to state here 
that vigorous reaction must be secured or the bath is a failure, with 
distressing and depressing effects. 

The physiological action of the cold plunge bath is that of a pow- 
erful excitant measure, and for that reason should never be indulged 
in by the weak or by those who have any heart disease either of a 
functional or organic character. The sudden impact of the body with 
cold water at this low temperature produces a powerful stimulation 
and refreshing effect upon the nervous system, quite similar, in a 
general way, to the action described in the Brand bath. Upon the 
heart and circulation this bath adds quite a considerable strain, as 
the blood suddenly leaving the periphery congests all the internal 
organs. It has little, if any, temperature-reducing influences, being 
too short in its duration. The reaction following the cold plunge is 
probably the most active of all hydriatic measures. The therapeutic 
indications of the plunge are few. The author wishes to enter a strong 
protest against the custom, that is prevalent with many general prac- 
titioners, of ordering the cold plunge for nervously exhausted and 



176 PRACTICAL HYDROTHERAPY. 

run-down patients. To say the least, it shows a total ignorance of 
the action of this bath and a lively disregard of the dangers attendant 
upon its use in these cases. 

Surf Bathing. 
This form of hydriatic procedure is, as a rule, limited to those 
who can reach the seaside, and is rarely indulged in unless the water 
is warm and pleasant. On the Eastern coast the time of year varies 
with the latitude, and this is equally true of the Pacific coast, bathing at 
some places in Southern California and Florida being available during 
the winter months. To the strong and vigorous sea bathing is one of 
the most delightful and invigorating of all aquatic sports. It possesses 
a delightful esthetic side, that enhances the pleasure materially. A 
fine beach, brilliant sunshine, bright costumes, the roar and rush, the 
splash and dash of the oncoming "white caps," all promise exhilarating 
participation, calculated to elevate the spirits and increase the activity 
of the circulation. Chemically, the ocean is a strong solution of com- 
mon salt, the following being an analysis of its water : 

Chloride of sodium 25.1 

Chloride of potassium 5 

Chloride of magnesium 3.5 

Sulphate of magnesium 5.78 

Sulphate of lime 15 

Carbonate of magnesium 18 

Carbonate of lime 02 

Carbonate of potassium 23 

Iodides and bromides . ......... traces 

Organic matter traces 

\Yater 964.54 

Total 1,000 

The bather, dressed in a thin bathing attire, with a preliminary 
promenade in the warm sun, plunges into the rapidly moving water, 
subjecting the cutaneous surface to the stimulating influence of the 
waves. It will readily be seen that we have here combined the influ- 
ence and effect of a percutient hydriatic application, and it is not far 
amiss to say that surf bathing closely resembles the douche. The 
author is such a firm believer in the many advantages to be derived 
from the use of surf bathing that he feels a few words are essential 
for the government of those who prescribe and use this bath. The 
water usually ranges from 60° to 75° F. ; the maximum duration 
should be approximately twenty minutes. It has been my personal 
observation that the action of the bath is materially enhanced by 
dividing the time of immersion with intervals spent upon the beach 
in the sunshine and in active exercise. By the repetition of short 
"dips" in the ocean, extending altogether possibly over three-fourths 
of an hour's duration, all the influences that go to make up surf 



THE TECHNIQUE OF HYDROTHERAPY. 177 

bathing are more satisfactory and active in their effects. Here, again, 
we must not lay all the values that are derived to surf bathing alone, 
for we have the very best and purest of air, brilliant sunshine, toning 
and enhancing every tissue and function. Associated with this are 
the physical activity of the body and the swimming in the water. 
Those who live in towns, away from the seashore, have always seemed 
to me to be more especially benefited by surf bathing and its concomi- 
tants than those who reside at or near the seashore. To the man 
and woman living in large cities, cooped up the better part of the 
year in ill-ventilated and poorly lighted offices, whose skins are inactive 
and leathery, whose digestion is weak, whose nervous system is let 
down, there is nothing equal to even a short sojourn of two weeks at 
the seashore, daily battling with the active surf. To these it is, as 
near as possible, happiness unrestrained, with the joy of air and earth 
and water, with the absence of conventionalities and all the latitude 
that comes with it. This return to the wild and savage life, where 
the skin is exposed to the sun's rays and to the cold waves, produces 
a wild exhilaration that starts anew the bounding impulses of life, 
and brings again to the system that vigor and elasticity that should 
be the heritage of health and youth. It is just such return to "Na- 
ture's own" that enables the denizen of the densely populated centers 
to return again to the battling and struggling necessities of life. If 
the individual is strong and powerful it simply renovates and recre- 
ates ; if anemic and run down, it restores ; if weakly, it strengthens. 
Even in robust individuals, however, but one bath should be taken 
daily, and in surf bathing, as in all other hydriatic procedures of a 
tonic character, the writer believes it should be taken before 3 p.m., 
always on an empty stomach, or certainly not until two hours have 
elapsed since eating. It is an excellent plan to arrange the bath so 
that upon leaving the surf the bather can go directly after robing to his 
lunch. The bather must avoid entering the ocean while the body is 
fatigued or chilled, and where the reactive power is poor the plunge 
in the surf should be of very short duration, not exceeding a minute 
or two, followed by slow walking in the sun and exercise movements 
of the arms. If, after dressing from such a bath, a genial glow suf- 
fuses itself over the sensitive surface of the body and is succeeded 
by a pleasing warmth internally, accompanied by a refreshed and in- 
vigorated feeling, it is evidence and proof of the salutary influences; 
but if, instead, there follow a chilliness, languor, headache, irresistible 
depression and disposition to drowsiness, or any of these, it should 
be reckoned as important evidence that the bath has not contributed 
in any material way to the advantage or improvement of the person's 
health, and that, if persisted in under similar or like conditions, the 
result will in time prove injurious. If these precautions are observed, 
both by the vigorous and sickly, much can be gained from a course 



178 PRACTICAL HYDROTHERAPY. 

of surf bathing, for it will be found that the appetite and digestion 
improve, the secretions become better in quality and quantity, the skin 
healthier, the nerves stronger, the mind clearer and the body more 
active. I am satisfied from no small observation that many persons 
fritter away the benefit of their summer trip to the seashore by inju- 
dicious, improper and excessive indulgence in surf bathing, and at the 
same time fail to follow those hygienic laws of which "early to bed and 
late to rise" forms a most excellent basis. 

Sea bathing is contraindicated in those cases in which the arterial 
elasticity for any reason has been changed or lost, as in arterio- 
sclerosis and capillary fibroses ; also where the peripheral vessels have 
ceased to respond to reflex stimuli, or in any case or condition in 
which the stimulation of the bath would be likely to favor or to pro- 
duce internal hemorrhage ; in organic heart disease, recent rheuma- 
tism, cholelithiasis, acute gastro-intestinal or febrile diseases, or any 
disease whatsoever in which the normal resistance has been so reduced 
as to make it necessary to protect and guard the patient's forces. 

Miscarriage may be caused by bathing when the sea is particularly 
rough. Sea bathing is also prejudicial to health during the menstrual 
period. It is worthy of note that otitis media frequently follows 
bathing in a rough sea, as well as frequent and prolonged exposure 
in the water. 

Swimming Bath. 

In this connection it is pertinent to consider the swimming bath, 
which, to a great extent, possesses a similar value to that of the ocean 
bath. There is no question but what swimming in rivers, ponds, 
lakes, streams, artificial reservoirs, and the like, is of great value, 
both as a hygienic and therapeutic procedure. The same rules and laws 
that govern surf bathing are applicable to swimming in still water, 
with this difference, that as the water is not moving, and therefore 
is free from one of the stimulating effects incident to surf bathing, 
the duration of the swimming bath in ordinary water should be 
shorter, and as a rule not exceed fifteen minutes. 

It is well here, as in surf bathing, to intermit the immersion by 
exercise between the plunges. In surf bathing and swimming the 
bather should not remain in the water until he becomes chilled, or 
until the lips are blue, for where the bath is carried to this extent it 
is usually succeeded by a feeling of lassitude, chilliness, headache and 
general discomfort. The presence of these symptoms indicate that 
the bather has remained too long in the water. 

Should cyanosis appear in the lips, the bather must immediately 
remove the bath costume, if possible step into a foot-tub of hot water, 
at the same time applying vigorous rubbing to the body with warm 
dry towels. When reaction is established it should be followed by 



T) 



8 



c 



Cd 



3 
crq 




r 



o 
I 

n 

o 






o 
o 



o 



* 




THE TECHNIQUE OF HYDROTHERAPY. 179 

gentle exercise, preferably walking in the sunlight, for fifteen or 
twenty minutes. 

Swimming pools, open to the public, possess some dangers. The 
rules do not compel a thorough cleansing bath with soap, and even if 
this were so, the water soon becomes contaminated by surface excre- 
tions due to the exercise and from the buccal secretions that are care- 
lessly expectorated into the water. These unhygienic conditions, in- 
separable from a public pool, are the means of spreading skin, eye 
and ear diseases. Especially common is a furunculosis of the external 
auditory meatus and conjunctivitis. This does not occur where lakes, 
rivers and streams are used. 

Mineral Baths. 

Medicine from time immemorial has had her follies, and hydro- 
therapy has likewise not been free from such delusions. Among the 
prominent hydriatic lapses may be mentioned the following baths : 
Mineral acids, chloride of calcium, iron, sulphur, tan, bran, malt, 
glue, milk, whey, blood, wine, horse-dung, guano, oak bark, starch, 
soup, corrosive sublimate, etc., any one of which has stamped on its 
face lack of common sense and charlatanry of the purest ray serene. 
I think it may be stated with practically no fear of contradiction, save 
by those who operate mineral springs, that there is no evidence what- 
soever at hand to substantiate the statements that certain mineral 
substances dissolved in water, in such infinitesimal amounts as are 
found in the natural waters, can have any special value to the cu- 
taneous surface. It seems to me that these baths possess value only 
as they produce the same thermic and other impressions upon the 
periphery that are to be derived from the use of plain, unmedicated 
or simple waters. The laity are very apt to be led astray in their 
estimate of mineral waters and their virtues as an internal beverage 
and as an external hydriatic weapon against diseases, seeming to 
forget entirely the major factors of absence from business, freedom 
from care and worry, open air and pleasant surroundings, all of which 
tend to produce a rejuvenation of the system, aside from the mineral 
water. 

The author has visited many mineral springs of this kind, and 
prides himself upon the fact that while he has tasted, he has never 
used any of the waters, and has secured as much good and benefit 
from his sojourn as the most eloquent and flannel-mouthed exponent 
of their accepted virtues. Of course, this does not mean that there 
are not some springs that possess value, but my observation and ex- 
perience lead me to believe that those waters naturally heated have 
given the best results per se, which I believe to be due to the fact that 
patients gain spoliative benefits that may be derived from the appli- 
cation of any water at a high temperature. It will be seen that even 



180 PRACTICAL HYDROTHERAPY. 

in these instances a remnant of a doubt remains. Probably of all 
mineral baths that are most popularly sought the sulphur bath is the 
most common, and I believe that no thoughtful man will for a mo- 
ment entertain the belief that there is the slightest benefit to be ob- 
tained from the addition of sulphur to the water used. European hy- 
driatists who practice at the great spas, and who utilize their waters, 
take a much broader view of this matter than their American con- 
temporaries, a notable instance of which being the Schott brothers, 
at Nauheim, in Germany. The time is fast approaching when the 
medical profession should post itself thoroughly regarding this rap- 
idly expanding farce. It does not mean that hydrotherapy shall not 
be utilized at springs, but that it should be utilized in an intelligent, 
far-seeing, scientific manner, freed from charlatanry and quackery, 
and administered to patients based upon a thorough knowledge of 
the physiological action of thermic values. In this connection it is 
interesting to note again what has been most frequently referred to in 
previous sections of this work, that the water contained in the bath 
is not absorbed by the skin — ergo, what is the value of the mineral 
constituents to the bather? It must be borne in mind that in the Nau- 
heim bath, one of the few mineral baths recommended, it is not the 
contained mineral so much as the presence of an active, effervescent 
carbon dioxide gas, which is not absorbed, that does the work, acting 
through the peripheral nerve terminations in the skin surface. 

Douches. 

In nearly all of the preceding methods of treatment that we have 
considered the human hand has taken an active part in the applica- 
tion, but in the douche the physiological effects are obtained by the 
use of apparatus which drive or throw the water upon the entire or 
various portions of the skin surface. The many forms of application 
of hydrotherapy reach their acme in the douche, and this instrument 
of therapy is the aim and object of most operators, for by its use the 
most powerful physiological effects may be produced. The douche 
is the most satisfactory, flexible and adaptable tonic in hydrotherapy, 
and is capable of producing changes marvelous to those who are un- 
acquainted with its use and effects. It should be noted that in douches 
we have to deal not alone with thermic impressions upon the sur- 
face, but with mechanical effects as well, which are of a perturbating 
or concussive character, and while this latter plays an important part 
in the effects of the douche, yet the temperature effect is in reality 
the most important. It is to be noted in all methods by which water 
is driven against the human body that its action is strictly limited to 
the moment of its application, as the water at once flows or falls from 
the surface. A douche, therefore, is the application of water to 
the body surface in single or multiple columns or streams at dif- 













r~ —l - ~ — -- 


















^v 










/^«\ \ 




1 i l 




H 


* ^IfeS^KSiWi^fiiic 


&*? 


;■',',' 




V 




. 


— b! 










in 










I 






ijH 




1 


H. 1 

^8^S®B^ '-'1 


I 


m 


St[ 




MB 


i J 


w^ 






























1 1 












Tf$ If ^^ 










r 






! 


11 




( 


1 






! 11 










V 














Tl 




ij_ 




L ][ 
























1 












\ fff« 




K' 1^ 




\J!I 




" i i ^ i 





Plate 101 — Author's Douche Apparatus. 



THE TECHNIQUE OF HYDROTHERAPY. 181 

ferent temperatures and under varying degrees of mechanical stimu- 
lation, the latter derived from atmospheric pressure. There are dif- 
ferent kinds of douches. They may be administered from a nozzle 
with an opening so fine as to make the application painful, or broad 
like a fan, or as multiple little streams. Each and every douche may 
be hot, cold, or may be alternate hot and cold ; in the last named the 
sudden thermic changes enhancing the physiological action of each 
temperature. In like manner the mechanical stimulation may be of any 
grade of strength from the mildest to the most powerful. It should, 
however, be borne in mind that the physiological action of an affu- 
sion, the mildest douche, and the jet, the most powerful, is one and 
the same, the difference in effect lying more particularly in the vari- 
ations of the method and in the pressure used. Douches are, as a rule, 
more agreeable to the majority of individuals than the other forms 
of hydriatic procedure, because by its stimulating mechanical action it, 
in a brief period, not alone produces its effect, but hastens and in- 
creases reaction. For this reason in institutions, sanatoria and hospi- 
tals, especially where the chronic invalid is treated, the douche is much 
employed, not alone for its well-known therapeutic power, but be- 
cause of its brevity of application, which makes it popular with the 
patient and saves much valuable time where many are to be served. 
I am of the opinion that in the douche we have the most powerful and 
far-reaching of the therapeutic weapons, and one that should be more 
frequently used. Those who have never used (personally) a powerful 
douche have missed a pleasant experience, and were physicians to try 
this measure more frequently upon their own persons I am confident 
they would have less recourse to medicines in chronic diseases and 
make more use of hydrotherapy. It sets the tissues in a vibration 
impossible to describe ; experienced, it is never forgotten. The writer, 
after eighteen years' practical experience in a large practice, and in the 
daily use of hydrotherapy, is at a loss to differentiate physiological dis- 
tinctions, niceties, and need for separate consideration of "liver, spleen, 
epigastric, perineal, ascending and descending, etc., douches," so much 
insisted upon by French and German writers and by some hydriatists 
in this country. Owing to anatomical differences in structure and 
its varying vascular distribution, certain reflexes may arise that are 
different in one place from those in another, but the difference is so 
small that it can be overlooked in view of the simplicity and clearness 
that is gained by reducing the subject of douches to its simplest terms. 
Following the plan heretofore insisted upon, the writer will give a 
brief description of each "douche method," its peculiarities and ad- 
vantages, and will then give the physiological action, therapeutics, etc., 
of douches in general. I will consider douches under four headings, 
proceeding from the simpler to the complex and more powerful. 
Douches are divided as follows : 



182 PRACTICAL HYDROTHERAPY. 

1. Affusions. 

2. Shower or vertical rain bath. 

3. Circular rain, horizontal rain, needle or spray bath. 

4. Jet douche (jet or fan). 

Douches are administered by means of certain attachments that 
are in connection or conjunction with what is known as the "douche 
apparatus." In constructing the douche apparatus we should have 
delivered to it, in pipes not less than one and one-half inches — the 
author uses two — hot, cold and ice water, under a sufficient pressure 
to secure satisfactory results. It should be in direct connection with 
both hot and cold water supply, and so arranged that the use of hot 
and cold water elsewhere will not interfere with its operation. Eighteen 
years ago the writer constructed a simple and efficient douche appa- 
ratus which serves him excellently to this day, and which can be seen 
in the accompanying cut. This apparatus is attached to the wall, and 
consists of two separate and distinct divisions, both of which are sup- 
plied with the three kinds of water, the left hand division being con- 
nected with the circular needle bath, triangle and perineal douche, the 
right hand one with the jet and fan douches. This apparatus is con- 
structed of one and one and a half inch brass nickel-plated pipes, and 
the three kinds of water are delivered to the mixing chamber, from 
which a single pipe conducts the water to the respective pieces of ap- 
paratus. The apparatus is so arranged that, in giving the alternate or 
Scottish douche, hot water may be obtained from one side and cold 
from the other, the apparatus thus meeting every requirement of a 
correct treatment apparatus. The mixing chambers are supplied with 
accurate thermometers, and a gauge shows the amount of pressure 
employed. With this very simple instrument of precision water may 
be applied in any form of douche with rapidity, facility and accuracy. 
The writer has used, and has in his sanatorium, one of Dr. Simon 
Baruch's douche-tables, a picture of which is shown, and of which its 
originator has the following to say: 

"The douche-table is a box four feet long, three feet high and two 
feet wide, covered with marble. Enclosed within the box is a com- 
bination of pipes connected with the hot and cold water and steam 
supply on the one hand and a hose with other terminal arrangement 
on the other. The hot and cold water supply is by the usual con- 
trivance controlled by stop-cocks, the terminal rods and levers of 
which issue through the opening in the upper portion or slab of the 
douche-table, as may be seen in the diagram. The outflow pipe, con- 
trolled by the stopcock, regulates the pressure of the water, which is 
plainly indicated upon the gauge. This enables the attendant to ar- 
range any pressure required, either before the douche is adminis- 
tered or while it is flowing upon the body. A thermometer is so ar- 
ranged that its bulb, incased in an openwork metal tube, lies within 
the mixer and shows the temperature of the water flowing upon the 



> 



r 



o 
o 




THE TECHNIQUE OF HYDROTHERAPY. 183 

patient. A second clock furnishes information regarding the dura- 
tion." 

It is from these apparati that the various forms of douches are 
administered, and which we will now consider, the only exception being 
the affusion. 

Affusicn. — The "affusion" is a procedure by which a stream of 
water issuing from a bucket or pitcher is thrown or falls upon the 
patient sitting or standing in an empty tub. The writer uses the affu- 
sion with comparative rarity, and, as a rule, only in connection with the 
half bath or for some local effect. It has been his experience that 
it is best to employ a bucket provided with a partial covering 
and large opening through which a broad stream of water may be 
concentrated more or less upon the patient. It will be seen at once 
that the affusion can be made stronger or weaker according to the 
temperature of the water and the height from which it falls. It is 
my custom to generally administer the affusion from 55° to 70° F., 
and I have found that it is advantageous for the patient to be sitting 
and to administer it to both the chest and back. This, in connection with 
the half bath with friction, has been a favorite method of the writer's 
in treating locomotor ataxia, and to which the reader is referred in 
the section upon therapeutics. It has been suggested by Baruch that 
in conditions of coma, delirium and adynamia the patient should sit 
or recline in water at a temperature of 100° F., and receive the affu- 
sion at temperatures varying from 45° to 60°. He says : 

"It is this method by which Currie made his remarkable cures in 
typhus fever, using chiefly sea-water on board the ship. In scarlatina, 
when the system is overwhelmed with poison, the circulation embar- 
rassed, the skin pale or marble or cyanotic, the respiration shallow, 
temperature high, pulse rapid and feeble, truly marvelous results may 
be obtained by the judicious brief use of affusions. Reaction occurs 
rapidly, and with it come an improved peripheral and general circula- 
tion, deepened inspiration, bright countenance and roseate skin. Let 
not the fear of cold water deter anyone from resorting to cold affu- 
sions, 70° to 60° F., in these desperate cases." 

It is always a good plan before administering the affusion to have 
the patient's face and neck thoroughly cooled. There is just a little 
knack in giving the affusion, and that is to swing the bucket to a suffi- 
cient height so as to cause the water to dash against the patient; in 
feeble patients, where the affusion is applied to the chest, it is well to 
have the patient break the first part of the stream by placing his hands 
against the chest wall and then quickly removing them. 

Shower Bath. — The shower bath, vertical rain, or rain douche, 
as it is variously styled, consists of a perforated disk from which a 
large number of fine streams of water fall upon the patient. This ap- 
plication resembles somewhat the effect of the circular rain or needle 



184 PRACTICAL HYDROTHERAPY. 

douche, owing to the large quantity of water that flows over the body 
surface. The temperature effects are practically the same as in all 
douches, but the mechanical or pressure effects are less than in the 
next two forms to be considered, although it is greater than in the 
affusion. The rows should be so arranged that the water can be made 
to fall upon the head at an angle when this is so desired, as some pa- 
tients are exceedingly sensitive to water falling straight down upon 
their head. This is a procedure of considerable value, and is quite a 
stimulant to the nervous system, and possessing many of the valuable 
effects of the douche. This is the favorite percutient measure in pri- 
vate homes, and the shower or vertical rain is now a part of nearly 
every well-kept private bath-room. In sanatoria, as a rule, the rows 
permit of larger volumes of water under greater pressure than is found 
in private houses. The shower is a part of the standard apparatus 
manufactured by companies who deal in plumbing supplies, and is 
easily obtainable at reasonable prices. 

Circular, Horizontal, Rain, Needle or Spray Bath. — In my sana- 
torium I employ two kinds of circular, needle or rain baths, one of 
which is the old-style needle bath supplied with semicircular perforated 
pipe and attached to one of the mixing chambers of the douche appa- 
ratus. To the left of it stands a circular needle bath, popularly termed 
in the institution the "triangle," which was originated by Baruch, and 
which the author has had in use for a number of years. This con- 
sists of three standard upright brass nickel-plated pipes to which are 
attached four or five rosettes, three inches in diameter, containing ap- 
proximately fifty fine openings, the three upper rosettes so arranged 
that the stream of water may be directed downward, so that a person 
of short height will not receive the volume of water upon the face and 
head. In the older circular rain bath the writer has obviated this 
difficulty by the use of three stools of different sizes made of cedar 
wood. The circular rain or needle bath is a very active and powerful 
procedure, and by its use one is enabled to obtain far-reaching effects. 
The multitude of fine streams under considerable pressure falling upon 
a large area of cutaneous surface, stimulate by their thermic and me- 
chanic effects all the structures immediately in contact with the water, 
and arouse extensive reflex action. It is a milder procedure than the 
jet douche and a stronger one than the shower bath. This bath has in 
the writer's hands yielded him some of the most satisfactory results ob- 
tainable in the whole field of hydrotherapy, and it would be difficult 
to substitute as effective a weapon should this be lost to the profession. 
It is especially valuable for women, many of whom do not stand well 
the stronger jet douche. 

Jet Douche. — The jet douche or "hose," as it is called in the par- 
lance of the bath-room, consists of a hose attached to cne of the outlet 
pipes of the douche apparatus, and to the other end of which is a metal 





Plate 105— Shower Baths. 




Plate 106 — Affusion to Chest. 



J . 

















1 




1 


1 


! U 


„ L _L 




,1,1.1 





\ i ii\ \\\\wv\ 

Plait. 107 — Circular, Horizontal Rain or Needle Bath. 



THE TECHNIQUE OF HYDROTHERAPY. 185 

connection to which can be screwed various attachments for modifynig 
the size and shape of the stream delivered to the patient. The jet 
douche is usually administered through a nozzle, the diameter of the 
opening ranging from one-fourth to one-half inch. As before stated, 
the douche apparatus should be so arranged as to possess two of these 
jets in order that the Scottish douche may be administered. The jet 
douche is, in the opinion of the writer, from careful clinical observa- 
tion and from long personal experience, the most powerful of all forms 
of hydriatic treatment. Administered at high or low temperatures, 
under a strong pressure, it is capable of arousing the most sluggish 
and intolerant function of the human body. It is a powerful invig- 
orant, revulsive and sorbefacient when administered as a Scottish 
douche for local conditions, especially of a chronic inflammatory na- 
ture, particularly when located in the extremities. 

The fan douche is nothing more or less than a very simple modi- 
fication of the jet douche, and while there is a special nozzle or attach- 
ment for producing the fan douche, the author would not advise its 
use, as it is really objectionable rather than beneficial. The simplest 
way of producing the fan douche is to place the finger over the nozzle 
of the jet so that the water will fall upon the patient in a broadened 
and thin stream. In this way certain structures that would be unable 
to stand the action of the jet douche gain all the value of this appli- 
cation without having sensitive parts subjected to the pain and dis- 
comfort that the full jet might produce. In case the temperatures 
used are too high, and the force of the stream too strong for the human 
finger to stand, by the use of a small piece of wood, preferably of 
cedar, the stream may be broken without having the attendant suffer 
any discomfort from the temperature administered. It is the writer's 
favorite method to combine the fan and jet douches, using the fan 
douche upon the chest and the tender walls of the abdomen, and the jet 
douche upon the spine, back, lower limbs and feet. It is for this reason 
that I do not advise the use of a special nozzle, as it would compel the 
removal and reattachment of these nozzles several times, during the 
interim of which the patient would become chilled, thus robbing him 
of all the benefits that the douche commands. 

The perineal douche is a modification of the jet, and is applied 
through a nozzle directed from the floor, the patient being seated upon 
a stool through which a hole has been bored to permit the stream to 
reach the perineum. This douche is of some value in the treatment 
of sexual weakness, prostatic troubles and hemorrhoids. It should be 
gently applied at the start and gradually increased in force. 

The Scottish or alternate douche is simply the alternate application 
of a hot jet douche followed by a cold jet douche. While it is generally 
employed as a jet douche, still it may be applied in almost any form 
of douche. In the application of the Scottish douche it should be 



186 PRACTICAL HYDROTHERAPY. 

borne in mind that there is, as a rule, a ratio between the application 
of heat and the application of cold. Roughly speaking, it is usually 
four or six to one — that is to say, the hot application should, as a rule, 
be long and the cold application short. Reducing it to time, the hot ap- 
plication should range somewhere between one-half and three minutes, 
and the cold application from five to thirty seconds. The aim and ob- 
ject of the Scottish douche is to intensify the revulsive effect obtained 
from both the application of the hot and cold water. Where we have 
to deal with conditions that are local and which especially affect tissues 
such as joints, sciatic nerve, etc., an excellent method of treatment is 
to precede the use of the Scottish douche by a general sweating method. 
Its application combines all the physiological influences of both the hot 
and cold douches, and, in fact, rather intensifies their action. It is one 
of the most powerful absorbents of inflammatory material that can be 
placed in the hands of the therapeutist. It produces, in addition, a 
marked mechanical influence. The temperatures usually administered 
range from 100° to 125° F., while the temperatures of the cold water 
range between 55° and 70° F. 

It may be stated that a sine qua non to its successful use is ability 
to manage and direct the forcible impact of water upon the whole body 
or any part of it ; the operator should be able to control the form, 
temperature, pressure and duration of the douche. It should be no- 
ticed that variations in temperature and pressure are easily distin- 
guished by patients. 

Practical common sense will at once see that while there is a dif- 
ference in the effect of water acting in a concentrated form, as in a 
jet douche or in the separated multiple little streams of a circular 
needle douche, yet this is only a difference in degree and extent rather 
than an ultimate physiologic difference. Douches are usually admin- 
istered at temperatures ranging from 45° to 120° F., and where they 
are very hot or very cold they should be of brief duration and act as 
a stimulant, increasing tone and well-being. Hot douches (104° to 
110° F. ) should not exceed, in general applications, a half to two min- 
utes, preferably as an average one minute, the hotter the douche the 
briefer the time. Cold douches (45° to 70° F.) should not exceed, in 
general applications, ten to thirty seconds, preferably as an average 
fifteen seconds, and likewise should be proportionately briefer the 
lower the temperature. It is an excellent rule to commence treatment 
with a temperature of 100° F. for one minute, followed by a reduc- 
tion to, say, 80° F. for ten seconds, increasing the hot water one de- 
gree daily until 104° F. is reached, and reducing the cold water two 
or three degrees daily until 60° or 50° F. is reached, and in like man- 
ner increasing pressure steadily. 

Cold temperatures are secured in summer by ice water obtained 
by passing water through a coil of pipes surrounded by ice. This is 




Platk 108 — Perineal Douche Apparatus. 




BR 

Plate 1C9 — Perineal Douche. 



THE TECHNIQUE OF HYDROTHERAPY 187 

only necessary in summer. In some places water of sufficiently low 
temperature is obtained by sinking deep wells, thus obviating the trouble 
and expense of the ice-box. 

The jet is usually administered with the patient standing, but if 
he be quite feeble he may sit. In many cases it is well to combine the 
different forms of the douche in an application, beginning perhaps 
with the warm circular needle douche, finishing with the cold fan 
douche over the body and the cold jet to the spine, legs and feet. 
Where the entire body is treated we would expect general physiolog- 
ical effects, and where the applications are local purely local and re- 
flex effects. The most pronounced local effects are found in the Scot- 
tish douche. The douche should never be administered except upon 
the order or under the medical direction of a well-trained hydriatist, 
as it is too vigorous an application for the uninitiated or to be left to 
careless routine treatment. The jet douche is usually applied to the 
back first, then the legs and arms, and then slowly broken for the 
chest and abdomen, and lastly to the feet. Where general effects are 
desired, and some local effect in an organ is sought, the cold jet should 
be applied as a finishing application over the part it is desired to most 
influence. The action of the douche, as in many other measures, is 
enhanced by some procedure that has for its object the increasing of 
the cutaneous circulation, the collection of heat upon the surface and 
the increasing of skin sensitiveness. To this end the wet and dry pack, 
superheated dry hot air, the hot-air box, steam box, the incandescent 
electric light, the arc light, etc., are used. After no inconsiderable 
experience, I feel that the general requirements are more nearly met 
by the incandescent electric light bath than any other known method, 
and I give this preference except in special cases. The aim and object 
of the douche is to bring the patient, as soon as possible, under the 
influence of low temperatures and high pressure. The favorite method 
of use, however, is first to give a hot or warm douche, following same 
by a cold one of brief duration. The douche should always be kept 
moving, and by so doing many disagreeable sensations of heat or cold 
will be obviated. 

Reaction is more immediate and complete, for the colder water 
and briefer application, coupled with the mechanical stimulus of the 
impact, overcomes the depressing effect of the low temperatures ; in 
fact, the skin frequently reddens under the cold water during its appli- 
cation in those whose reaction is well developed. Owing to the limited 
areas over which various douches play, and the accompanying massage, 
they do not produce the painful impressions as if the patient was 
totally immersed in cold water. The author believes that the best re- 
sults are obtained from brief douches under considerable pressure and 
thermic change adapted to the individual case. The douche encourages 
both thermic and circulatory reaction — the former brought about by 



188 PRACTICAL HYDROTHERAPY. 

rapid cooling of the skin surface, the latter because of the intermit- 
tent mechanical vibrations of the stream upon the surface. It will 
thus be seen that all douches depend for their effects upon six fac- 
tors, viz. : 

1. Form — affusion, circular needle, jet. 

2. Temperature — hot, cold, alternate hot and cold. 

3. Duration — short or long. 

4. Pressure — amount of mechanical stimulation. 

5. Distance — from attendant. 

6. Local and general applications. 

Physiological Action of the Hot Douche. — This has been incident- 
ally considered in the foregoing remarks, but we will now take up and 
consider in detail the physiological action of the hot douche. The 
temperatures range from 100° to 125° F., though the latter or higher 
temperatures are only borne after hydriatic education. Local applica- 
tions may be made at much higher temperatures than general ones, 
higher with moving than with still water. 

The influence upon temperature is to first produce a reddening of 
the skin owing to the close relation between temperature and vascular- 
ity. The temperature of the body is raised if the application is general 
or a local rise if localized, this increase being due to the prevention of 
heat elimination and by increasing its production. 

Its influence upon circulation is active. The first and transient 
influence is to contract the peripheral blood-vessels, followed almost 
immediately by dilatation, atonic in character and causing a passive 
congestion of the skin, which becomes of a cherry-red color. The 
heart is first slowed, with temporary increased force of puis* beat, 
but soon it becomes accelerated, due to dilatation of the arterial system 
in the skin, coincident with perspiration and a lowering of arterial 
tension. As a reflex effect the internal blood-vessels are contracted. 
The cerebral blood-vessels may dilate at the start and give a sensation 
of oppression in the head, of tightness and throbbing. Later the 
dilated peripheral blood-vessels cause a reflex contraction of the cere- 
bral ones, causing an internal anemia, especially of the brain, demand- 
ing in both instances cold applications to the head. 

Upon respiration the influence is to increase their number, diminish 
their depth and to produce a slight feeling of weight and oppression 
upon the chest. Moist heat produces these effects at a much lower 
temperature than dry heat, and in the latter inhalation of the hot air 
increases the effects. There is a greater heat loss by exhalation and 
respiratory activity. 

Upon metabolism, the most intricate process of vital action, the 
effect is to increase the action, directly stimulating perspiration, the 
glandular action of the skin, and increasing the elimination of waste 



THE TECHNIQUE OF HYDROTHERAPY. 189 

material by increasing the secretion, elimination and oxidative pro- 
cesses of the body. 

Upon the nervous system heat is a powerful excitant, and where 
long continued may lead to exhaustion. Applied to the nerve termin- 
ations in the skin, its influence is conveyed to the spinal cord and 
thence to the heat centers in the medulla, stimulating vital processes. 
These sensory impressions are of a powerful character, and give rise 
to myriad reflex effects. After a short time stimulating effects give 
way to relaxing, sedative and depressing influences, well known to 
those who use the hot bath. Headache, sense of fullness or band-like 
feelings about and around the head, giddiness, lightness and cerebral 
oppression are some of its later effects. Upon the peripheral nerves 
it is, under low pressure, analgesic, under high pressure stimulant. 
Muscular nerves are markedly influenced, spasm being overcome and 
relaxation taking place. 

Reaction is transient and is followed by atonic conditions. 

Therapeutics of the Hot Douche. — Its principal value is that of a 
preparatory or alternate to the cold douche, and is rarely used alone. 
Where we have to deal with superficial tenderness, hyperesthesia, in 
neuralgia, etc., it sometimes proves of value alone, but the writer has 
found even in these cases the necessity exists for following their 
application with carefully graduated cold applications. The hot 
douche reaches its maximum value in connection with cold percutient 
measures, and is only valuable in this connection. 

Physiological Action of the Cold Douche. — The writer is firmly 
of the opinion that the cold douche should never be used without the 
preliminary and preparatory influence of heating procedures or the 
hot douche. Cold applications of low temperature is the aim of the 
hydriatist, together with maximum mechanical stimulation. 

The action of the cold douche upon temperature is to primarily 
produce a chilling of the surface and contraction of blood-vessels. 
The capillaries of the skin contract, the flow of blood to the skin is 
checked. The douche does not reduce systemic temperature, for the 
system rallies to overcome its effect, the development and production 
of heat being increased. The temperature of the surface in contact 
with the cold water may be lowered, but only temporarily. The per- 
cussive or mechanical effect of douches lessens the impression of cold, 
and lower temperatures may be advantageously administered. 

Upon the circulation the cold douche is decisive and tonic in action. 
During its immediate application the heart's beat is increased, the 
pulse is smaller, but the subsequent effect is to lessen the number of 
beats and to markedly increase the volume of the pulse, while at the 
same time the flow of blood through the heart is accelerated. There 
is a rise in blood pressure under its use, but a secondary diminution 
takes place when the peripheral blood-vessels are filled by reaction. 



190 PRACTICAL HYDROTHERAPY. 

Immediately under the stream of water the skin becomes blanched, 
followed by a return of color as the stream moves and is allowed to 
fall on another part, probably due to the weight or concussion of the 
water driving the blood out of the tissues. When reaction takes 
place the blood-vessels moderately dilate, retaining what is called 
"tone" or tonic reaction, and this in the douche is noticeable even 
in the smallest blood-vessels. For the maintenance of the general 
circulation there is nothing, in my opinion, comparable to the cold 
douche. The quality of the blood and the number of corpuscles are 
greatly increased after a bath. The douche is always short in duration, 
thus causing it to act as a general tonic, stimulating the heart's action 
as well as bodily functions. 

Upon respiration the cold douche immediately causes an increased 
and deepened respiratory act, thereby favoring the exchange of gases, 
with an increased absorption of oxygen and elimination of carbonic 
acid gas. The sudden impingement of the douche causes the chest 
movements to be of much greater amplitude. There is a certain amount 
of sensation of gasping and restriction of breathing, but this can be 
easily overcome by simply opening the mouth widely. With the 
absorption of oxygen there is an increase of the general oxidative 
processes of the body, thus reducing the complex chemical composi- 
tion of toxins to those simple elements that are easily and rapidly 
removed from the body. 

Upon metabolism it is the most powerful of stimulants. It arouses 
functionation to the highest degree. The douche is eminently a 
destructo-constructive agent, destroying and removing waste material, 
first by better oxidative processes induced, and secondarily by the 
stimulus it gives to excretion. By the better destruction and elimina- 
tion of toxic waste materials physiological proce>se^ are given an 
opportunity to follow the natural law of reconstruction and repair. 
Upon chronic metabolic and toxic conditions it is the summum bonum. 
Not only does it increase these processes, but all secretory and gland- 
ular organs are aroused, so that the secretion is greater in quantity and 
better in quality. Because of this action we find that the digestive and 
assimilative processes become more effective, the appetite is increased, 
more food taken, digested and assimilated. The lymph current is 
accelerated in the channels and glands, making this accessory circula- 
tion more effective in normal tissue regeneration. Flesh is gained and 
strength renewed. It has been demonstrated by numerous investigators 
that elimination is greatly increased as well as accelerated, Strasser 
having shown that all waste products are increasedly removed from the 
body by the douche. Urea, the purin bodies, nitrogen, uric acid, ex- 
tractives, etc., are destroyed; the specific gravity of the urine is 
raised and the liver stimulated to destroy gastro-intestinal poisons. 

Upon the nervous system the douche exercises an influence 




Plate 113 — Jet Douche. 




Plate 11-4 — Jet Dorche to Spine; Patient Should be Farther Away and Stream 
Straight and Powerful as in Plate 113. 



THE TECHNIQUE OF HYDROTHERAPY. 191 

equalled by no other procedure in the domain of therapeutics, and 
this statement is made with a full appreciation of its meaning. The 
action of the douche upon the nervous system is brought about by the 
mechanical and thermic impressions, which impinge in rapid succession 
upon the peripheral nerve terminations in the skin, energetically stim- 
ulating and arousing their action. In the action of the douche upon 
the various functions of temperature, circulation, metabolism, etc., 
the nervous system is a large factor in the production of both the 
immediate and reflex effects, for distant influences depend entirely 
upon nervous impressions and are dominated by their action. The 
reflex influences of neural action are enhanced by the mechanical 
effect of the impingement of water. The cold douche is tonic in 
action — a general invigorant, producing a feeling of elation and 
strength. Immediately after its use sensation is enhanced and the 
skin becomes hyperesthetic. Reflex excitability is increased, nerve 
centers are aroused, especially those that preside over neuro-cardio- 
vascular structures. In its impingement upon the skin the douche 
gives rise to tactile and other sensations, and in this way differs from 
other hydriatic measures. Pressure influences the peripheral nerves 
according to its force, its extent and its variations ; it sets in action 
myriads of reflexes, both afferent and efferent, producing thereby in 
the economy a new balance in which excesses and defects in function 
are corrected and physiological labor divided. That it increases nerve 
force and nerve regeneration is patent daily to those who use it in 
their practice, it being equally true that it redirects misspent and 
irregular nerve force into reparative and functionating channels. The 
most important results obtainable in hydrotherapy are secured by its 
use with less tax upon the neural and general strength than by any 
known measure. It is alterative, vitalizing, restorative. Upon the 
mental functions it increases their activity, acquisitive, productive and 
reproductive. On many occasions the author has found recourse to the 
douche one of the most effective and satisfactory methods of relieving 
mental and physical fatigue and of increasing the activity of his higher 
mental faculties. 

Upon the muscular system Maggiora and Vinaj have demonstrated 
the marked increase in muscular power following the douche, together 
with increased capacity for work. In a large number of clinical ex- 
periments made by the author upon his own person he has confirmed 
these results ; and, furthermore, it has a peculiar neuro-muscular 
refreshing and invigorating effect, felt for many hours after its 
application. The motive power of the unstriped muscular tissue is 
much increased, and this is probably one of the many reasons why 
the stomach, intestines and other viscera are made more active. The 
muscular coats of blood-vessels respond with selective activity to its 
action in connection with vascular and neural effects. By the in- 



192 PRACTICAL HYDROTHERAPY. 

creased muscular action heat is liberated, toxins and acid products 
squeezed out, followed by better tissue regeneration. 

Therapeutic Application. — The douche is rarely used in acute dis- 
eases, but finds its greatest field in chronic affections in which we 
wish to obtain a controlling influence over circulation, nutrition and 
nerve tone, for in those conditions accompanied by anemia, poor 
circulation, malnutrition, nervous and digestive disorders, and against 
chronic exudates and inflammations, it is a weapon by which we may 
successfully attack conditions otherwise impossible to reach. In chronic 
diseases of the chest, in catarrhal states of the bronchi, it stimulates 
expectoration and facilitates absorption, this latter being especially 
true of the chronic exudates of pleurisy and pneumonia. In func- 
tional and inflammatory diseases of the entire digestive tract results 
little short of marvelous are obtained by a course of douche treatment. 
We find that atonic, nervous and secretory disturbances are corrected, 
appetite and assimilation improved, flesh gained. 

In many of the phychoses — melancholia, neurasthenia — of the de- 
pressed and general type, in morbidity with introspection, in hysteria, 
in many cases of chronic neuritis, neuralgia, sciatica and other nervous 
affections, there is no weapon equal to the douche in restorative power. 
In the chronic rheumatic, whose toxin-laden body and metabolic pro- 
cesses are so warped, the douche sets in vibration the entire economy, 
and, relieving it of its load, soon enables Nature to assert her won- 
derful restorative power. Where deposits have taken place in the 
joints, where stiffness and ankylosis without destruction have taken 
place, when preceded by the use of superheated dry hot air the alter- 
nating or Scottish douche is the method par excellence, and soon 
brings about lessened pain and increased mobility. Where the con- 
dition popularly known as "stiff back," stiff neck, or a true myositis 
exists, where there is muscular soreness after an acute rheumatic 
attack, the douche proves an absolute panacea. 

In those cases of anemia and chlorosis where iron, arsenic and 
other hematinics fail the douche alone will cure, but in conjunction 
with these useful drugs the hemoglobin and corpuscles daily increase, 
a fact frequently demonstrated by me from actual laboratory ex- 
perience and test. Where the skin is dry and inactive or gray and 
greasy-like, due to improper condition of its circulation and glandular 
action, nothing so quickly removes the condition as the stimulating 
thermic and mechanical action of this form of hydrotherapy. In the 
sedentary and in those who are unable to take the required amount of 
open-air exercise, a short course of this form of hydrotherapy once 
or twice a year or once or twice a week will often add many moons of 
usefulness and activity to the individual. In the fashionable and 
dissipated, in those affected with "dyspeptic livers," the douche soon 
rehabilitates and rejuvenates. 




Plate 117 — Shower Bath. 



INFECTIOUS DISEASES— FEVERS. 193 

It can be Used even in feeble cases, for, abstracting no heat and 
favoring speedy reaction, invigoration, not depression, is its result. 
In cases of inebriety and the morphine habit the douche occupies one 
of the highest places in modern methods of treatment, relieving the 
enslaving thralldom and building up vitality. 

In conclusion, it must be again repeated that unless reaction is 
secured the aim and object of the use of these douches is defeated 
and the benefit to be gained thereby lost. 

Contraindications. — Especial care should be exercised in the use 
of the douche in the aged, in those suffering from respiratory troubles, 
and in those affected with arterial sclerosis, aneurism and atheroma. 
In myelitis, locomotor ataxia, acute neuralgias, multiple neuritis, gas- 
tric ulcer, acute gastro-intestinal catarrh, cystitis, acute rheumatism 
and eruptive diseases, the cold douche is forbidden. While forbidden 
in the acute phases, in the chronic cases it is useful. 



CHAPTER XL 
SPECIAL THERAPEUTICS; INFECTIOUS DISEASES; FEVERS. 

The author realizes the shortcomings that are to be found when- 
ever one attempts to condense into a few brief lines a compact state- 
ment of a disease or disorder, but he feels that these defects are 
those of omission rather than commission. It is a regret of his that 
ample space could not be given to the full and technical description 
of each disease considered in this section of therapeutics. Were this 
done, the size and scope of the work would be so changed as to pre- 
vent the original purpose being carried out. The brief descriptions 
are merely intended to refresh the memory of the practitioner and 
impress the student with the salient points of the why and wherefore 
that should be kept in mind while perusing the method of treatment. 
In this way it is believed a better grasp of the subject will be ob- 
tained by those who refer to the therapeutic section for reference 
only. To some it may seem a needless thing to do, but the author 
believes that it will prove of benefit to all those who are interested 
in this form of therapeutics. 

No attempt has been made in this section to produce any more 
than what might be termed ordinary "good English," and it may pos- 
sibly seem to some that certain words have been much overworked; 
while this may be true, the author feels that, in spite of this, he has 
done wisely in sacrificing style and beauty of language to plain simplic- 
ity and absolute clearness, and with this in view a certain formula of 
expression, as it were, has been adopted, in order that the practitioner 
and student may very easily and rapidly grasp the meaning and in- 
terpret the work. Too often authors are condemned for lack of clear- 
ness in directions, that are fogged because they fail to realize that 
their readers do not comprehend the subject with the facility and 
ease of specialists and those of well-trained minds. The simple state- 
ment that "so-and-so is good in this disease'' has been avoided, and 
an endeavor made to state plainly, simply and concisely not only 
what method to use, but how to use it, what treatment should follow 
this, and every detail necessary for the tyro, for the fact remains 
that nearly 98 per cent, of medical men are tyros in the domain of 
hydrotherapy. The author has so often experienced this dissatisfac- 
tion in the works of others that he has in his own work endeavored 
not only to remind the reader of the disease in hand in a succinct 
manner, with a brief pathology, but has tried to suggest what should 
(194) 



INFECTIOUS DISEASES— FEVERS. 195 

be first, what second, etc., ad infinitum. It has been his rule that 
wherever several lines of treatment are suggested, to indicate which 
has in his experience proved the most satisfactory and efficient; fo'r 
he has found that many of the measures reputed to be of value have 
been those handed down in books of this character, copied and re- 
copied without that investigation and elimination which a practical 
test must always bear to the theoretical and scientific in a work of 
this character. In other words, it has been his aim everywhere to 
suggest that which in his own experience has proved of use and 
value, separating the wheat from the chaff, a labor of some difficulty 
but of vast importance. In some diseases, such, for example, as 
Asiatic cholera, he has been compelled to accept what seems to him 
to be the very best recommendation of several authors whose experi- 
ence in this line justifies him in believing their suggestions to be of 
value, but with these few exceptions he has hewn strictly to the line 
of his own work, trying to give due value and recognition to the ex- 
cellent work done by others in this field. 

At times it may appear as though there were a great similarity 
between the treatment of certain diseases, and to this impeachment 
the author can only plead that, if it be true, it is simply because those 
treatments have been found equally valuable in both forms or phases 
of diseased tissue or function. It will, however, probably be seen 
upon close analysis that real variations exist, although at first glance 
they might not appear to be present, for it will oftentimes be found 
that the general plan of treatment having for its object the upbuilding 
of the nutritional state of the patient should be used in both cases. 
the variations consisting in such localized treatment as the individual 
disease may demand, the two going hand in hand, thus constituting 
a difference. 

The author has tried to avoid being too dogmatic, nor has he in 
any sense reached the opinion that hydrotherapy is the sole and only 
cure to be used. This he knozvs to be true — that hydrotherapy is, 
of all single therapeutic methods, in his opinion, most potent, the 
remedy par excellence; but there are other means and measures 
that may be used that often aid and assist in restoring cases to health. 
It were foolish not to adopt them in conjunction with any form of 
rational therapeutics, and to this end he has frequently suggested a 
proper dietary, hygiene, exercise, and other treatment that would 
assist and be supplementary to the action of hydrotherapy. The 
enthusiast might claim that hydrotherapy alone will cure disease, 
but in conjunction with other methods its action makes cure more 
certain, and as the aim in this section is to make the therapeutics of 
water easily available, successful, and in many instances to enhance 
other treatment, the author has undertaken the task of enlarging upon 
the scope of his work in order to make it more accessible and effective. 



196 PRACTICAL HYDROTHERAPY 

Every endeavor has been made to steer clear of the bias usually 
manifested in special works of this kind, and for that reason a clear 
conception of the modern idea of disease and of the general methods 
by which the case is managed will probably prove of service. 

The author wishes again to state for the benefit of those who 
never read prefaces that during his active experience of eighteen 
years he has not been in any sense limited to the use of hydrotherapy, 
but has had at his beck and call a well-equipped sanatorium, trained 
nurses, hygiene, diet, gymnastics, massage, mechanical vibration, elec- 
trification — galvanic, faradic, static, sinusoidal and high-frequency; 
light treatments — X-ray, Finsen, incandescent, blue — all that the 
pharmacopeia can offer — and for this reason he believes he is all the 
better fitted to discerningly separate the goats from the sheep, to 
estimate accurately the value of hydrotherapy as compared to other 
measures of treatment ; and should he suggest in many instances 
other well-known methods in conjunction with hydriatics, it is be- 
cause experience has taught him their paramount value in these cases. 

The busy practitioner will consult this section, and in order to 
save time each section is made complete. He will find diet lists and 
associated measures, as well as some medicines, named, the combina- 
tion of which has given the author much satisfaction. In the index 
cross-references may prove of value and assistance. In conclusion, 
it may be stated that a study of the preceding sections has doubtless 
impressed the reader with the necessity for the correct use of hydro- 
therapy in disease. He must have realized that this remedy is by 
all odds the most flexible of his therapeutic equipment, an agent that 
may be found in any home, which can be applied in hundreds of 
conditions, provided that the temperature, duration and mechanical 
effects be carefully studied in relation to the particular case in hand. 

Simple Fevers. 

There come under the observation of the family physician many 
cases of simple fever, characterized by a moderate elevation of tem- 
perature, free from any contagious or infectious micro-organism, 
and having their origin from divers causes. They are usually of short 
duration, and due mostly to disorders of the digestive tract, exposure, 
"catching cold." or over-exertion, both physical and mental. They 
usually present fever, gastro-intestinal trouble, headache, lassitude, 
quick tense pulse, increased respiration, hot skin, scanty urine, etc. 
In these cases hydrotherapy obtains some of its most gratifying re- 
sults, for in cottage or castle the means are at hand. Give a calomel 
and aloin purge, and restrict diet. In sthenic cases do not feed. Urge 
the drinking of large quantities of water, to the extent of one gallon 
per diem, which may be flavored with fruits to suit the individual 
taste. Xo medicines are needed, as a rule. Commence at once by 



INFECTIOUS DISEASES— FEVERS. 197 

using the cold sponge, repeated every two or three hours. During 
the interim apply the cold abdominal compress at 60° F. for one hour, 
and repeat after each sponging. I have seen much benefit result from 
a preliminary use of the hot full bath, as hot as can be borne, fol- 
lowed by wrapping in blankets and the free use of hot water in- 
ternally. Two hours later use the cold sponge and compress. Where 
the fever is not promptly controlled by these measures, we can com- 
mence the use of the full cold bath every three or four hours at 80°, 
with friction for five minutes, decreasing the temperature five de- 
grees with each bath and increasing the duration one minute. The 
great advantage of these measures lies not alone in the relief of the 
simple febrile process, which it will certainly accomplish, but should 
the fever mask an infection we have placed our patient in the best 
possible position, having increased his vital resistance and become 
well acquainted with his reactive power. Hydrotherapy is the method 
par excellence.. 

Typhoid Fever. 

The importance of fully understanding the method of treating 
this disease cannot be overrated, as it is the most common, most im- 
portant, and practically the ever-present of the acute infectious dis- 
eases. Typhoid fever, because of it's large mortality, because of its 
frequency and amenability to hydriatic procedures, demands that the 
physician have a clear conception of the essential conditions to be 
met, and be possessed of all therapeutic resources to meet the re- 
quirement. Typhoid or enteric fever is an acute infectious disease, 
due to a specific toxin, generated by the typhoid or Eberth bacillus, 
characterized by symptoms referable to the nervous (headache, stu- 
por, delirium) and gastro-intestinal systems (red tongue, becoming 
dry and brown, abdominal tenderness, diarrhea, tympanites), a pe- 
culiar eruption upon the skin, rapid prostration and slow convales- 
cence. The constant lesions are found in Peyer's patches, the mesen- 
teric glands and spleen. The disease is excited by the entrance of the 
bacillus into the alimentary tract by means of contaminated water, 
milk, ice, meat, celery, lettuce, or other substances. Flies frequently 
aid in disseminating the disease. Peyer's patches become infiltrated, 
then necrose, soften and slough, leaving ulcerated surfaces, which 
in recovery are succeeded by cicatrization. The spleen undergoes anal- 
ogous changes, except ulceration, and the heart, liver and kidneys 
are the seat of parenchymatous or glandular changes. From the pro- 
dromal to the convalescent stage five essential points are of great 
interest. 

1. The presence and persistence of nervous symptoms, such as 
malaise, headache, insomnia, delirium, stupor, coma, "typhoid state," 
etc., etc. 



198 PRACTICAL HYDROTHERAPY. 

2. A weakening of heart action and a rapid pulse. 

3. An elevation of temperature. 

4. Failure of elimination. 

5. 'Marked mortality. 

Of the complications, hemorrhage and perforation are the most 
important. Mortality is variously estimated from 14 to 25 per cent, 
under the -expectant" treatment, which percentage truly assumes an 
"expectancy" unpleasant to contemplate. Under the various "modi- 
fied" bathing systems, I am convinced a fair average is 7.5 per cent. 
While Brand 1 has reported 2,150 cases treated by his strict method, 
commencing before the fifth day, with no deaths, and has collected 
from German sources 19,017 cases treated by "all kinds of cold baths" 
with a percentage of 7.8; while many American practitioners have 
small numbers of cases with no deaths, still it may be said that a 
rough general percentage of deaths, where the strict method has been 
employed, ranges, as far as I can estimate same from literature and 
personal information, between 3 and 4 per cent. This difference of 
three or four lives per hundred were enough to induce the more fre- 
quent use of the full method. The Medical Times (1903) says that 
no drugs are employed at Johns Hopkins Hospital, where they have 
the largest number of cures. 

With this short and condensed epitome, we are ready to consider 
the treatment of this disease. 

The patient should be placed in bed in a quiet, well-ventilated 
room, the temperature of which should be kept between 60° and 65° 
F. Avoid draughts. An intelligent and painstaking nurse is an es- 
sential element in the successful handling of the case, but frequently 
this desideratum cannot be obtained, and an obedient layman must 
be substituted. The bed is best single, of metal, with woven wire 
mattress, two blankets, a plentiful number of sheets and pillow 
covers. The drinking-water should be boiled and then cooled in a 
refrigerator kept in an adjoining room, thus protecting the patient 
from further infection. The most scrupulous cleanliness must be ob- 
served, the bed-pan being used through the entire disease and steril- 
ized with boiling water after its use. The discharges should be dis- 
infected with a solution of chloride of lime or formaldehyde. All 
utensils must after use, be washed in the disinfectant solution and 
afterward in very hot water. The nurse should protect herself by 
using no food, water, glasses, etc., that are used in the room, and 
should cleanse her hands and forearms scrupulously after each con- 
tact. Discharges after disinfection are best buried. Linen must be 
boiled before washing. Diet should be liquid and consist of diluted 
milk, broths, buttermilk, sour milk (yogurt bacillus), and albumen 
water, which may be flavored with lemon or orange, preferably the 

1 Deutsche med. Woch., 1887. 



►fl 



I 



Cd 




INFECTIOUS DISEASES— FEVERS. 199 

latter. Milk is, by common consent, the best diet, and is more pal- 
atable and useful diluted with Vichy water, though lime water may 
be used. Salt must be added. For a change it may be peptonized or 
koumyss used. Oyster stew, minus the oysters, is a palatable method. 
Five ounces is sufficient. I believe in the free administration of cold 
sterile water — as much as a half-gallon in the twenty-four hours — as 
it quenches the thirst and removes waste products and toxins. Cushing 
and Clark 2 gave this amount in small doses, eight ounces every half- 
hour when awake, while every two hours six ounces of milk and six 
ounces of albumen water were administered. During the night these 
latter were given once or twice. They noticed there was less nursing, 
fewer complications and no deaths. Polyuria was marked, closely 
corresponding to the fluid ingested. Headache, apathy, restlessness, 
nocturnal delirium and deafness markedly lessened. The tongue and 
mouth kept clean and moist, nausea was infrequent, fever remissions 
present. Toxemia was notably diminished. The author has found 
in fevers that flavoring the water ingested with fruit juices, lemon, 
orange, apple, raspberry, etc., enables the patient to drink more 
freely, in larger quantities, while at the same time these juices act 
as mild antiseptics and possess a fair amount of nourishment. I am 
not much of a believer in whisky except in emergencies, and believe 
heart action is better sustained by other measures, as we shall see 
later, though Baruch administers whisky or brandy just before the 
Brand bath. One should aim to nourish and bathe at or about the 
same time, in order to avoid fatiguing and disturbing the patient too 
often. It is doubtless a good general rule to commence treatment 
with a calomel purge. 

Hydriatic procedures should be at once utilized, before even the 
diagnosis is made, for no harm can be done bathing febrile patients, 
and much danger accrues from delay. If in doubt as to diagnosis, 
we can commence the use of the cold sponge. In order to be effective 
the surface of the body must be made quite wet. Commence the 
sponge with water at a temperature of 80° F., and reduce the tem- 
perature five degrees each successive application until 60° F. is 
reached. This ablution may be repeated every two hours if the tem- 
perature registers 100° to 101° F. One great advantage of this pre- 
liminary hydrotherapeutic treatment is the preparation it gives the 
patient and the clear index we obtain of his reactive capacity. 

If now the diagnosis is made unequivocally of typhoid, the prac- 
titioner has four methods to select from — to continue the cold sponge 
and compress already instituted; the tepid full bath with friction at 
85° to 80° F. for fifteen to twenty minutes, followed by the abdominal 
compress at 60° F. for one hour, change once or twice; the neutral 
bath at 95° F. for twenty to thirty minutes, with friction, followed by 

2 American Journal of the Medical Sciences, March, 1905. 



200 PRACTICAL HYDROTHERAPY. 

the abdominal compress at 60° F.; the full Brand bath. I do not 
believe in or recommend packs. 

The time has come when the hydriatist must speak with no small 
voice concerning the use of the cold bath, experience having fully 
determined its efficiency. The author has never been the victim of 
typhoid, but should he become so infected would not hesitate one mo- 
ment upon the method herewith outlined. The strict method laid 
down by Brand and followed to the letter by medical men who mould 
opinion in Europe and America is the mainstay of the progressive, 
honest and painstaking practitioner of to-day. Cabot has shown 
the great value of the sponge as given in the Massachusetts General 
Hospital, of its revivifying influence and its temperature-reducing 
power. Taken as a rule, the patients do not seriously object to the 
ablution or sponge at 65°, 50° or 40° F., while many object to the 
strict Brand method. By the strict Brand method I mean the admin- 
istration of a cold full bath at 65° F. for fifteen minutes, accompanied 
by friction, whenever the temperature per rectum reaches 102.5°, and 
described in detail on another page. 

It must be said with regret that this method grows slowly with the 
American profession. It is absolutely essential to use sonic method 
at the earliest possible moment, and a plan that frequently works well 
is to start the patient with a full bath at 90° F., three to five minutes' 
duration, using friction ; decrease the temperature two degrees for the 
next five baths and lengthen the time two minutes until the bath is of a 
temperature of 80° and fifteen minutes' duration; drop one degree 
for the next five baths, continuing them fifteen minutes until 75° 
is reached, and if your patient and family do not object, drop in the 
same manner to 70° and 65° F. Never forget to use friction, though 
it must not be too severe. In very old and very young persons, 90° 
F. for ten or fifteen minutes is usually better than the colder bath, 
which they stand badly, for children have larger skin area to their 
weight and feebler heat-producing powers. It is not a bad practice 
to once daily cleanse the skin of the patient by the use of green 
soap just before giving one of the baths. These baths should be re- 
peated four times daily. Many authors find the cool enema at 75° 
to 80° F., once or twice daily, an adjunct, emptying the bowels, re- 
moving germs and toxins. Thompson 3 says that if the patient shivers 
after the bath, give Hoffmann's anodyne, dr. i in aqua camphorae 
oz. i. If these measures are followed, and the bath method cautiously 
introduced, little objection will be encountered, and Americans, pro- 
fessional and lay, gradually educated to what some have very unjustly 
termed "barbaric procedures." As the maximum febrile temperature 
begins to decline the temperature of the baths should be gradually 
raised to 85° or 90° F. During the entire course of the disease the 

3 Medical News, April 8, 1907. 




Plate 119 — Brand Bath — First Stage (Cohen's "Physiological Therapeutics"). 




Plate 120 — Brand Bath — Second Stage (Cohen's "Physiological Therapeutics"). 



INFECTIOUS DISEASES— FEVERS. 201 

heart may be energized, the circulation improved, and some reduc- 
tion in temperature secured by the judicious use of the ice-bag over 
the heart for fifteen to twenty minutes every three or four hours. 
Its use should never be omitted. 

No matter what method is employed, the judicious use of the 
cold compress enhances the effect of the hydriatic procedure adopted. 

A discussion at this point of certain features of the treatment 
may not be amiss: 

1. The nervous system in its entirety, from prodrome to con- 
valescence, feels the brunt of the attack. This is shown by the malaise, 
headache, insomnia, somnolence, tremor, subsultus, delirium and coma. 
For this reason the influence exerted by hydriatics, and especially 
the Brand bath, places them at the fore as the weapon par excellence, 
and those who know from experience rely upon it. so exact and 
scientfic are the results. What, then, is the result of hydriatic 
applications? Instead of the toxins sweeping over the nervous 
system and drowning it, the nerve centers, lower and higher, are 
aroused from their lethargy by the powerful sensory impressions 
made upon the peripheral nerves, conveyed from the skin to the 
ganglionic centers first, then to the brain, and as a direct result 
general vital resistance is increased. In fact, it is a nerve tonic in 
febrile conditions analogous to the tonic action of the cold douche 
in chronic maladies. By preventing and overcoming the nervous 
symptoms it removes seme of the most distressing and alarming con- 
ditions, and, in addition, tends to shorten the grave period of the 
disease. Its action in dilating the peripheral blood-vessels causes a 
powerful fluxion from the brain, cleansing it from the accumulated 
poisons and giving the nerve centers a chance for rest and recupera- 
tion. Great comfort, quiet and refreshing sleep are indications of 
this bath's favorable action upon the nervous system, and the influ- 
ence of the bath upon nerve action in its turn increases cardiac action, 
as shown by slower and better pulse. One of the most gratifying 
effects is the clearer intellect, thus enabling the patient to intelligently 
aid in the treatment, a factor of no mean importance. 

2. In all the range of medicine and surgery cardiac action and 
pulse-rate are of vast importance, and their condition and consider- 
ation is one of the first problems the practicing physician takes up at 
the bedside. Like the spectre of Banquo's ghost, the fear of heart 
failure hovers around the bedside of each and every case in infectious 
disease, and any method by which this may be averted, by which 
the pulse and cardiac action are strengthened, is a welcome addi- 
tion. In the Brand bath we have a therapeutic measure second to 
none. 

Let us see why the heart and pulse weaken in typhoid fever. The 
cardiac muscle and the blood-vessels connected with it energize 



202 PRACTICAL HYDROTHERAPY. 

through the action of several mechanisms, the most important of 
which are its nervous connections with the cerebrum and spinal cord, 
the ganglia in the heart, along the blood-vessels and in the muscular 
tissue itself. All of these factors are under the influence of the vaso- 
motor centers and nerves. Enfeeblement and later failure results 
from the action of the toxins upon the central and ganglionic nervous 
systems, and a direct influence upon the muscular tissue, producing 
parenchymatous degeneration. As a result, we have feeble, rapid 
heart action, loss of tension and filling of the peripheral blood- 
vessels. If we are to believe the experiments of Paessler and Rhom- 
berg, this is due to the influence of the toxin upon the vasomotor 
centers within the medulla oblongata. There is no denying — and 
every observer confirms the fact — that in the bath of Brand, accom- 
panied by friction, we have an agent by which the vasomotor centers 
are stimulated, cardiac nerve action enhanced, muscle tone increased, 
and blood pressure raised, all of which are clearly shown in clinical 
work by a fuller, slower and better pulse. Its action upon the vaso- 
motor-neural mechanism is brought about through sensory impressions 
conveyed from the skin to the nerve centers, arousing them to action, 
and secondarily by the refreshing and invigorating influence that the 
contact of the cooled blood has upon the nerve centers, heart muscle 
and blood-vessels. As we shall later note, the benefit of eliminating 
toxins must be taken into account. The bedside observer will be 
quick to note that the pulse may even be small, but it has regained 
its power and possesses that feeling of normal tension pleasant to 
the finger-tips of physicians. 

3. In a careful review of the extensive literature of hydrotherapy 
in acute infectious diseases, the author has been struck by the fact 
that so many writers seem to insist that the temperature-reducing 
feature is the essential aim of this method, when, in fact, it is sub- 
sidiary, though none the less very valuable. It is doubly surprising 
when we find such masters as Brand, Vogel, Winternitz, Popeschal, 
Liebermeister, Strumpell, Ziemssen, Baruch, Kellogg, Wilson, Hare, 
Osier, Tyson, Delafield, Sihler, Welch, Loomis, Shattuck and a host 
of others, men whose experience is large, urging an entirely different 
view. 

Two factors cause elevation of temperature — increased heat produc- 
tion and lessened dissipation. These are governed by nerve centers 
whose function it is to regulate those influences which in health and 
under ordinary conditions would not affect the body or cause a rise in 
temperature. Heat production is increased by the presence of the 
patient in a warm medium, by muscular contractions, voluntary or 
involuntary, by the contraction of peripheral blood-vessels and mental 
effort. Heat dissipation depends largely upon the condition of the 
blood-vessels in the skin (contraction) and the temperature of the 




Plate 121 — Brand Bath — Third Stage (Cohen's "Physiological Therapeutics"). 




Plate 122 — Brand Bath — Fourth Stage (Cohen's "Physiological Therapeutics"). 



INFECTIOUS DISEASES— FEVERS. 203 

medium that surrounds the cutaneous surface. In the d'oove two sen- 
tences lies the full principles upon which the Brand bath acts. 

Let us see what takes place. The patient in a medium of water at 
65° F. would suffer practically no heat reduction unless friction was 
used, the loss of heat in the skin being compensated by muscular con- 
tractions. By the use of friction, however, the peripheral circulation 
is much stimulated, the blood-vessels relax and dilate and the blood 
coming in contact with the cold medium gives up its heat. The cooled 
blood returning to the interior is replaced by the heated blood, and 
reduction of temperature is the result. By friction, chilling and 
tremor are prevented, and a factor in heat production is thus elim- 
inated. It is now apparent why the bath must have a duration of 
some time in order to accomplish its results, and, further, why fric- 
tion, with its reactionary effects, is to be avoided after the bath. 

Temperature elevation is not the bugaboo it was formerly be- 
lieved to be, present investigation leading one to believe it to be a 
somewhat conservative process on the part of Nature in her endeavor 
to combat the poison and destroy the cause of morbid action. By 
the bath the reparative forces are brought out and the destruction 
as well as elimination of toxins hastened. This is accomplished by 
means of no toxic substances or antipyretics introduced into the circu- 
lation, which, as Baruch sarcastically remarks, "enable the patient to 
die without any elevation of temperature." The evaporation of water 
from a surface reduces temperature, a fact that is utilized in far 
Eastern climes to cool water. For this reason the patient is allowed 
to lie some little time in the sheet and blanket, being later gently 
dried. 

"A death from typhoid in the first week from excessive tempera- 
ture or failure of the nervous system is rarely observed ; the chief 
danger lies in the infective process, which undermines the system 
slowly but surely. To meet this danger, the cold bath is our shield 
and ever-ready weapon. In mild cases the rise of temperature and 
pulse is readily combated by it, the resisting power of the disease, 
being feeble. Hence the temperature rises only at long intervals to 
103° F., but, whenever it does so rise, the rule should be inexorable; 
the bath must be administered. Clinical experience demands it, and 
if we would receive its benefits we must obey the behest. The more 
nearly we approach the high standard of strict bathing, the more 
nearly may we approach the low mortality." (Baruch.) 

The influence of this bath upon temperature is to reduce same 
during the first week or ten days only a fraction of a degree, but by 
the end of the second week we may look for a drop of from two 
to five degrees after each bath, rising again in two to three hours to its 
former level. 

Febrile disturbances have two accompaniments always — hot dry 
skin and a concentrated and diminished urine. It is true of the 



204 PRACTICAL HYDROTHERAPY. 

application of water in general as well as in particular to the disease 
in hand that these conditions are met and overcome by cold applica- 
tions. To the tactus eruditus the hot, dry and pale skin of the 
febrile state is a true index to throw open the blood-vessels — "open 
the pores and produce perspiration." As we have already dwelt upon 
the dilatation of blood-vessels and increased skin activity due to the 
cold bath and friction, it is only necessary to state further that with 
the softening and removal of the debris of dead epithelium, the skin 
becomes soft, its glands proceed to act and the floodgates of the 
cutaneous surface are thrown open for the elimination of toxins, 
which we have shown in previous chapters is quite large. 

The urine, diminished in quantity, loaded with toxins of the disease 
and the detritus of tissue metabolism, gives a fair index of what must 
be the general condition of the circulating medium. There seems no 
dispute that these toxins and waste products, many of which are 
deadly, in turn enhance the general condition and increase the tem- 
perature. The ingestion of large quantities of water favors the hydra- 
tion of these poisons, rendering them more soluble, while the Brand 
bath, by increasing the action of the kidney, favors their prompt 
elimination. As a corollary, the respiration being increased, better 
CO, exhalation and oxygen absorption take place, and in the presence 
of sufficient oxygen these toxins, leucomaines, hydrotoxin products 
are consumed, rendered more soluble and easily eliminated through 
the better circulating blood current. Here we do not depart from 
general hydriatic principles of physiological action, but find that in 
acute infectious processes the same rule holds good. Cutaneous, 
respiratory and urinary increase of elimination is the direct result of 
the hydriatic treatment. 

5. The mortality of typhoid fever under expectant treatment prior 
to 1870 was high, ranging from 24.2 to 32.2 per cent., but in the past 
decade it has fallen to between 14 and 17 per cent. These percentages 
are, I believe, fair, and are the result of a search through a vast 
amount of ancient as well as current literature. Even under "com- 
promise" methods the mortality has dropped, until we can fairly 
state that it has reached 8 to 10 per cent., while under the strict Brand 
method the death-rate ranges from to 7.5, a fair average from all 
sources being, in my opinion, 3 to 4 per cent. These figures have 
been time and again presented to the profession, and in spite of all 
this the full method is not as freely adopted as it should be. There 
is in the American mind an inherent repugnance to cold water even 
in robust health, a shrinking and shirking that is remarkable to those 
who love its use. For this reason and for sentimental nonsense the 
patient and his family would run the risk of the loved one's death 
rather than submit him to the "terrible ordeal" of a cold bath. It is 
interesting to note the conclusions of all users of this method that 



INFECTIOUS DISEASES— FEVERS. 205 

"after a few baths the patient made no objections." It is much less 
pathetic to place a patient in a tub of cold water than to place him 
in a grave. If people will submit to the shock, anesthesia and other 
suffering of a surgical operation to save the lives of their dearly- 
beloved ones, why should they shrink from the Brand bath? It is the 
idea of hoiv disagreeable a cold bath must be. The method is easy 
to learn, and if in the Philadelphia and other hospitals colored men 
and women can learn to give these baths, certainly the Caucasian 
should regret to be classified below the descendants of Ham. 

Secondarily, as a result of increased cardiac action, increased 
arterial tension, better nerve action and oxidation, the functions of 
the internal viscera are improved. This is observed in better appetite 
and capacity on the part of the stomach to digest the food taken. 
Many foreign observers have so often found capacity in this line as 
to question whether it was not advisable to give a semi-solid diet ; in 
fact, the control of the patient in this respect may be necessary. 
Better conditions prevail in the bowel in that diarrhea and tympanites 
are much reduced by these baths. The liver plays an important role, 
for, standing as it does at the doorway of the portal circulation, it 
is flooded with toxins that arise from the viscera. Its circulation 
becomes weak, the organ congested and subject to degeneration. The 
increased fluxion of blood which the bath sets up empties the vessels 
of the stagnated and half-paralyzed liver, energizes to renewed activity 
the poison-benumbed ganglia which control it, arouses to its work the 
hepatic cell, thus renewing all the functions and maintaining the in- 
tegrity of this most important viscus. In fevers the number of 
corpuscles is greatly diminished, consequently the oxygen-carrying 
power of the blood is proportionately lessened. It is interesting in 
this connection to recall the fact that the white corpuscles are in- 
creased in number to a greater extent than are the red by cold 
applications. The leucocytes play an important role as defenders of 
the body, in destroying microbes, while the serum destroys bacterial 
toxins. What other agent known to man is capable of rendering 
such service as this? Acetanilid and antipyretics of all sorts diminish 
the blood count instead of increasing it, and thus greatly lessen the 
oxidizing power of the blood. 

Another most important service which the cold bath renders the 
fever patient is the amelioration of his discomforts. 'Medical men 
who have been subjected to this method of treatment while suffering 
from typhoid and other fevers have unanimously testified to the 
comfort which it secures. The brown, thickly coated, swollen and 
parched tongue, the sordes-covered lips and teeth, the catarrh of the 
stomach and bowels, the tympanites, hemorrhage, flatulence, exhaust- 
ing diarrhea, pneumonia, myocarditis, headache, mental stupor, ner- 
vousness, apprehension, paralysis, the cadaverous, ocher-colored 



206 PRACTICAL HYDROTHERAPY. 

appearance of the patient, are almost never seen when the cold bath 
has been administered from the very beginning. In spite of all these 
advantages, it is often difficult to secure the consent of the family, 
but the suggestion of Dr. Barker'' may be adopted, that to "overcome 
this prejudice he sends some missionary literature or sends the friends 
of the patient to some family in which the bath has been successfully 
used. After a few baths no argument is needed. He begins with a 
temperature of 90°, to secure confidence, and gradually lowers it." 

It is frequently urged that it is difficult to get nurses to perform 
the large amount of labor in the bath treatment, but the nurse who 
has watched and cared for a case of typhoid, with delirium, stupor, 
involuntary defecation and urination, will gladly accept the toil and 
worry of the bath treatment as less trying. 

Hydrotherapy is entirely safe when judiciously employed, and its 
use is free from serious objection. Brand says that all cases coming 
under treatment before the fifth day should recover. The use of 
medicinal antipyretics is attended by many objectionable features. In 
the use of antipyrine and other temperature-lowering drugs we have 
to deal with a depression usually followed by an elevation to a point 
higher than before. The depression of temperature is short, the heart 
action is weakened, elimination and oxidation become defective, being 
followed by a general lessening of mental and nervous power. In my 
opinion these antipyretic drugs should never be used or substituted 
for the bath treatment. 

The use of alcohol before or after the bath should be here dis- 
cussed. It is not maintained that preparation for the cold bath is not 
needed, but rather that there are better methods than by the use of 
alcohol. The ideal preparation is to be found in the application of 
heat. If alcohol in any way aids reaction it is not by augmenting the 
activity of the nerve centers, but by encouraging the relaxation of 
the surface vessels. Far better is it to start early and by so doing 
increase the reactive power of the patient, or use temperatures which 
do not occasion the patient so much discomfort or worry. I have seen 
this obviated in fevers and other conditions by the preliminary use of 
heat, as suggested by Kellogg, a hot fomentation to the spine or by 
hot-water drinking. Alcohol is a toxic drug, and its introduction into 
a system overloaded with toxins seems to me on its face irrational 
and illogical. If it has a place, reserve it for the emergencies. 

While cold baths may be used with impunity in ordinary cases of 
fever in which the general resistance of the body is good, and before 
the vital forces have been depressed by the long continuance of the 
disease, this is by no means true in cases in which hydriatic treat- 
ment has been neglected during the first week or ten days of the 



4 Barker (of St. Louis, Mo.), Therapeutic Gazette, 1894. 



INFECTIOUS DISEASES— FEVERS. 207 

malady. To plunge such a patient into a bath at 65° to 70° F. and 
retain him there for ten or fifteen minutes will most certainly imperil 
his life. By means of partial cold rubbings applied to different 
portions of the body successively, the cutaneous circulation may be 
marvelously improved without increasing, even momentarily, internal 
congestion. In the management of these grave cases, in which the 
life of the patient depends so much upon the exact and judicious 
employment of effective therapeutic procedures, it is important to 
remember that death in these cases, when attributed to so-called 
"heart failure," is really due to general collapse of the vital powers. 
The weak condition of the heart is a true index to the condition of 
the body as a whole. 

Under ordinary circumstances the presence of perspiration is 
evidence either that the febrile action is subsiding or that nature is 
doing all that can be done to lower the temperature and eliminate 
the toxin which is the disturbing element, and when this is the case 
the patient should be wiped dry before hydriatic measures are made 
use of. 

The presence of a dicrotic pulse and marked weakening of the 
first sound are indications of an asthenic state of the heart, in which 
it is wholly unprepared to meet the tremendous demands temporarily 
made upon it by placing the patient suddenly in cold water. In 
cyanosis the cold bath of Brand is decidedly contraindicated. This 
symptom is an indication that the movement of the blood is slowed 
as the result of cardiac weakness, and the heart is not prepared to 
sustain the shock of sudden and prolonged contact of cold water 
with the whole surface of the body, while the internal viscera, already 
profoundly congested in consequence of the cardiac inefficiency, would 
be endangered, especially the lungs, liver and spleen. 

The management of some of the more important symptoms, aside 
from the general treatment, is an important element, giving the 
patient comfort and satisfaction. It must be again reiterated that 
all symptoms are mitigated and often absent where the full method 
is used from the start. 

Headache. — Wet the hair thoroughly with water at a temperature 
of 40° F. and apply a cold compress or turban at 40° to 60° F., 
renewing same as it becomes warm. If very severe, apply sinapism 
to back of neck and use ice-cap or Leiter coil over compress. Keep 
room dark and urge patient to drink freely of water. Avoid use 
of morphine. 

Insomnia and Delirium. — These are best met by use of the half pack 
over abdomen and upper hips at 60° to 65° F., with cold compress to 
head. Occasional doses of bromides may prove useful. 

Diarrhea.- — The cold compress on abdomen will do much to pre- 
vent this condition, though three or four evacuations daily are not too 



208 PRACTICAL HYDROTHERAPY. 

many. If actions are foul or fetid, use a high enema of sterile water 
at 95° F. By this means the bowel is emptied and toxins removed. 
Avoid the use of medicines if possible. In like manner constipation 
is best treated. An oil enema is sometimes better where the feces 
are hard. 

Tympanites. — Use first a high enema of sterile water or saline 
solution to empty the bowel of all fermenting material, undigested 
food and toxins. Oftentimes much gas will be passed through the 
colon tube. Exercise great gentleness and care in introducing the 
tube. Look more carefully to the regulation of diet. Then apply a 
very hot fomentation for three minutes, repeat again and replace by 
the cold compress. Repeat fomentation and compress every twenty 
to thirty minutes as needed. 

Hemorrhage. — Administer morphine, J4 grain hypodermically, at 
once, and keep patient perfectly quiet. Give no food at all. Apply 
ice-bag over right iliac region or ice-cold compress to abdomen. Ice 
internally with freedom ; also fluid extract of ergot every three hours. 
If less severe, saline solution by hypodermoclysis and lower head of 
bed. In any event, call in a surgeon in consultation. The mortality 
of intestinal hemorrhage under the bath treatment is 6 per cent, as 
against 5.6 per cent, without the bath. 

Cardiac Collapse. — Immediately place an ice-bag over the heart, 
keeping same in position for twenty minutes. If this is not sufficient, 
hot fomentations over heart for one-half to one minute, followed by 
ice-bag, and strychnia or sparteine hypodermically. If baths are being 
used, raise the temperature; if they have not been used, follow out 
suggestion for late and neglected cases. Stop baths for a short time. 
This condition rarely happens under strict methods. 

Convalescence should be guarded, and as the patient regains 
strength the baths are discontinued and tonic hydrotherapy gradually 
increased. By this means nutrition and assimilation are improved 
and recovery quickened. 

La Grippe — Influenza. 

La grippe is now practically co-extensive with civilization. Within 
the last decade and a half influenza has penetrated to the smallest 
village and hamlet, its spread having been extremely rapid. I know 
of no infectio-contagious disease capable of producing such wide- 
spread havoc, such manifold and remarkably morbid pictures. 

The bacillus of influenza, or Pfeiffer's bacillus, possesses inter- 
esting features, and produces toxemia, bacteriemia, and inflammation 
(purulent). The influenza bacteria entering with the air into the 
respiratory organs settle upon the mucous membrane of the nose, 
throat and bronchial tubes, where they proceed to develop in enormous 



INFECTIOUS DISEASES— FEVERS. 209 

numbers and excrete those poisonous products which arise during their 
life activity. When they do not penetrate the mucous membrane the 
symptoms produced are those of a pure toxemia — that is to say, the 
poison is absorbed and circulating through the system produces distant 
effects ; or the bacillus may penetrate, enter the circulation and cause 
a true bacteriemia. The bacteria that have entered the circulation 
may settle in some organ or tissue, causing inflammation, followed 
by the formation of pus. 

The sputum is characteristic, of a greenish-yellow color, is 
tenacious, thick and adhesive, coming from the nose, throat and 
upper air-passages. In the sputum we find bacilli in large numbers — 
in fact, nearly a pure culture, showing as fine filaments, being the 
smallest bacillus cultivated. 

Of all the symptoms attributable to la grippe, we may safely say 
that those pertaining to the nervous system are predominant, and 
that this disease produces more organic and functional nervous trouble 
than any other acute infection. A careful study of the forms of 
grippe will show that the picture is never complete without a large 
number of nervous symptoms. Two conditions stand out prominently, 
owing to their frequency as sequelae of the attack, these two being 
adynamia or general debility, and neurasthenia. Nearly every case 
suffering from grippe experiences in some degree the debilitating in- 
fluence of its poison, this being shown in the slowness of recovery 
and the general sense of prostration and incapacity that follows the 
attack. I draw the distinction between these cases and those pre- 
senting the symptoms of true nervous exhaustion or neurasthenia ; 
the former might be more properly called neurasthenoid. Neuras- 
thenia following the grippe not only possesses the general run of 
symptoms in this affection, but in my experience has shown a peculiar 
tendency toward that of a depressed type — in fact, has at times 
bordered closely on to a psychosis, melancholy in character. These 
patients are apt to be morbid, and have a fear of the development of 
further serious disease. 

From what has gone before it is easy to see the many dangers of 
this disease; cases of grippe require careful and considerate hand- 
ling. The ordinary hygiene of the sick-room must prevail, and in 
addition the cuspidors should be filled with water in which carbolic 
acid or chloride of lime has been placed. Prevention is oftentimes 
worth more than a pound of cure, and for that reason members of 
the family and friends should not be allowed to kiss the patient, no 
matter how much their love and affection may lead them to osculate. 

The patient should be always provided with an alkaline antiseptic 
spray, with instructions to wash out the nose and throat every two or 
three hours ; thus the first element in the treatment is met by keeping 
the upper air-passages moist and open, the antiseptic destroying the 



210 PRACTICAL HYDROTHERAPY. 

bacillus or preventing its further development. The diet must be 
liquid, and to those who are strong but little should be administered. 
In elderly people and in those who are weak and delicate it must be 
administered every three or four hours. I have a very distinct and 
clear idea concerning the administration of whisky in conditions of 
the grippe. I never use it save in cases of heart failure in elderly 
people, and believe that it does more harm than good, as the action 
of alcohol is toxic in character and our aim and object is to eliminate 
poisons and not add them to the already overburdened system. 

In the treatment of the acute condition endeavor should be made 
to combat all tendency toward congestion and inflammation, especially 
that of the pulmonary and cerebral systems. Every effort should be 
made to reduce functional activity and drain the blood from them to 
the cutaneous circulation, this being best secured by maintaining 
warmth and activity of the skin surface. We can favor sweating 
by first administering a hot full dry pack for half an hour, followed 
by the cold sponge rapidly performed. This may be repeated as 
often as every three hours, and as the patient progresses the time be- 
tween should be lengthened. In sanatoria it is much more satisfactory 
to admininster the electric light bath in bed until perspiration takes 
place, followed by rapid cold sponging. Superheated dry hot-air, 
body apparatus, used promptly in the beginning, at 250° to 300° F., 
for twenty to forty minutes, followed by cold sponge (65° F.) or 
horizontal rain or circular bath at 75° F. for one-fourth minute, often 
cuts short the disease. When this cannot be utilized, the hot full bath 
at 102° to 104° F. for ten minutes, followed by a hot full dry pack, 
will be found serviceable. This may be administered once or twice 
daily during the acute stage. It may be followed by the cold sponge, 
rapidly performed. Another method of stimulating the vital resist- 
ance is the use of the full wet pack, commencing at a temperature of 
90° F., for thirty minutes, repeating every four hours. Reduce the 
temperature five degrees and increase the duration ten minutes until 
one hour is reached. Care must be taken in the administration of 
all of these methods to avoid general chilling of the cutaneous surface. 
With the subsidence of the acute manifestations of the disease 
our aim should be to maintain the general vitality by all known meth- 
ods. As soon as possible place the patient upon general measures. 
Commence with the daily use of the electric light bath, or hot-air 
bath, until perspiration takes place, followed by the dripping sheet 
for three minutes at 70° F. with vigorous friction ; reduce two degrees 
with each application until 60° is reached. As soon as the reaction 
of the patient has been fully developed we may proceed to the use 
of the electric light bath, full strength, until free perspiration ensues. 
Follow this by the horizontal or circular rain bath at 104° F. for one 
and one-half minutes, reduced to 70° for half a minute, pressure 



INFECTIOUS DISEASES— FEVERS. 211 

twenty pounds. Reduce temperature one degree daily until 60° F. 
is reached, and increase pressure two pounds daily until thirty pounds 
is registered. As soon as the patient begins to respond we may ad- 
minister the following: Electric light bath until free perspiration 
takes place, followed by the horizontal or circular rain bath for one 
and a half minutes at 100° to 104° F., twenty pounds, followed by 
the fan douche for one-half minute to the entire body, jet douche 
to the spine and lower limbs for one-fourth minute, commencing at 
a temperature of 70°, reducing two degrees at each treatment until 
60° is reached, and increasing the pressure two pounds until thirty 
pounds is registered. Should we have to deal with any of the in- 
flammatory or other troubles of the intestines, that are liable to follow 
in the wake of this most pernicious disease, we may apply the Scot- 
tish fan douche to the abdominal wall, in conjunction with other 
general hydrotherapeutic treatment. Where bronchitis or pleurisy 
develop these should be met according to the principles laid down 
under the treatment of these conditions, whether they are caused by 
the grippe or not. 

Malarial Fever; Intermittent; Remittent; Cachexia. 

This is an infectious fever, intermittent or remittent in type, char- 
acterized by the presence of chills, fever, anemia, and enlargement 
of the spleen. The exciting cause is the Plasmodium malariae of Lav- 
eran, which gains access to the human body through the bites of 
mosquitoes of the genus anopheles. These mosquitoes breed in dis- 
tricts that are marshy, their greatest activity being a period when the 
temperature is high, humidity present, and an absence of high winds. 
The mosquito is most predatory at night, a fact recognized in those 
districts. The various forms of chill and fever are well known, and 
occur at varying periods, dependent upon the development of sporu- 
lation of the parasite. As the spores are discharged into the blood- 
stream the chill takes place. Flagellated organisms are sometimes 
observed. The diagnosis of malaria should be made by the use of 
the microscope, though dependence is not to be placed upon the 
stained specimen, for in them the plasmodium is often absent, is in- 
fluenced by quinine and the time the blood is taken. For a number 
of years I have depended upon the examination of the fresh blood 
and the presence of pigmented white corpuscles for a diagnosis, and 
believe it to be an index more constant than any other I have used. 
The technique is simple, requiring but little time and trouble. Pat- 
rick Manson says that a pigmented white cell can only mean ( with 
two rare exceptions) malaria, and that if there be malaria present 
there will always be pigmentation. There is disintegration of the 
blood cells in the acute and enlargement of the spleen in the chronic 
forms. Preventive measures lie largely in the hands of local health 



212 PRACTICAL HYDROTHERAPY. 

officers, and should be directed to the draining of marshes and ponds, 
or, where this is impossible, the covering of such marshes and ponds 
with crude petroleum. In districts where malaria abounds the drink- 
ing-water must be filtered and boiled, the residents should avoid sleep- 
ing near the ground, and screen their houses. Persons should not sit, 
in the evening during spring and summer, where they can be bitten 
by the mosquito. Where screens cannot be obtained ordinary netting 
is useful. Recent Italian investigations have shown that five to ten 
grains of quinine daily is a protective of great value. "Quinine," 
say Marchiafava and Bignani/' "acts upon the malarial parasites in 
that phase of their life in which they are nourished and developed, 
when nutritive activities cease by an arrest of the transformation of 
hemoglobin into pigment ; when the reproductive stage begins, then 
quinine is ineffectual in action." For this reason, in these cases the 
quinia should be administered three to six hours before the attack, 
for three to four days, and repeated every seventh day for a month 
or six weeks. 

Hydrotherapy is of great value in malarial fevers owing to its 
powerful reconstructive effects upon the vital forces, its ability to 
increase the number and activity of the white and red corpuscles, to 
overcome the anemia, to favor elimination and general functional 
activity. The writer has had such ample demonstration of these facts 
as to assert the above without fear of contradiction. The treatment 
resolves itself into that of the attack and the interparoxysmal period. 
It is an excellent rule to commence with a calomel purge, five grains, 
with sodium bicarbonate. During the chill, administer hot drinks 
(water or lemonade), wrap the patient in warm blankets, put hot 
water bags to feet and sides, and use no cold hydriatic applications. 
The hot full bath ( 102° to 104° F.) for ten to fifteei. minutes, or the 
hot dry pack, or hot wet blanket pack, may be employed. With the 
cessation of the chill and the commencement of the hot stage the 
temperature rises, and we may now gratify the patient by allowing 
him to drink freely of cold water. We may now wait until this 
stage has lasted an hour, and if at this time the temperature has not 
fallen, and no signs of sweating being present, use the cold sponge, 50° 
to 60° F., taking care to avoid chilling the patient by drying each part 
thoroughly. When sweating takes place, wipe with a cloth until dry, 
and follow by rapid sponge with hot water, drying carefully there- 
after. In the remittent type we may employ the same general medi- 
cation and cold sponging, such as has been suggested in typhoid fever. 
The great advantage of hydrotherapy in malaria is during the inter- 
paroxysmal period, during which time we must strain every nerve 
to prevent recurrence by the judicious administration of quinine, and 



S Marchiafava and Bignam: "Malaria," Twentieth Century Practice of Medicine Vol. 
VII, p. 175. 



INFECTIOUS DISEASES— FEVERS. 213 

the use of iron and arsenic as tonics. Always insist on free drinking 
of water. If the patient is weak and confined to bed, continue with 
the use of the cold sponge, and in addition administer the dripping 
sheet at 50° to 60° F. for three minutes once or twice daily. If there 
is reason to fear another attack, give the full dry pack for thirty to 
forty minutes an hour before expected chill, together with hot-water 
drinking, or we may use the full hot bath ( 102° to 104° F.) for ten 
to fifteen minutes. As soon as the patient is up and about, adopt 
eliminant and tonic measures. Give the electric light bath, full strength, 
three to five minutes, the vapor five to ten minutes, or superheated 
hot air ten to fifteen minutes, or dry full pack until free sweating 
ensues. Follow this with dripping sheet, 50° F., for three minutes, 
or the horizontal or circular rain bath or the jet douche. The rain 
bath may be given at 100° for one minute, pressure twenty pounds, 
reduced to 50° for ten or fifteen seconds, increasing pressure and 
decreasing temperature daily. In like manner the jet must be grad- 
uated. Where the spleen or liver is enlarged the alternate or Scottish 
douche should be applied over the region of these viscera with tem- 
peratures ranging from 110° to 50° F., under a pressure of fifteen to 
twenty pounds, half minute for the hot, five to ten seconds for the cold, 
repeated two or three times. 

In the malarial cachexia or chronic malarial poisoning, a con- 
dition very commonly found, and in which the patient is anemic, his 
circulation poor, skin, conjunctiva and mucous membranes jaundiced, 
his spleen enlarged, weakness and emaciation present, temperature 
subnormal, with occasional febrile attacks, hydrotherapy is practically 
a panacea. I have had a most extensive experience with these cases, 
and feel certain of giving relief by hydriatic measures alone, though 
I generally administer iron, quinine, arsenic and strychnia. There is 
no question that water judiciously applied does the work, for as a 
rule the sufferer has already run the gamut of well-known medicinal 
remedies before utilizing hydrotherapy. It is marvelous sometimes 
to see the change wrought by a few weeks' treatment used as above 
(interparoxysmal period). Where hydriatics are used, smaller doses 
of quinine and tonics become effective, due to the better assimilation 
of the drugs, a fact frequently noticeable in a few clays. In the per- 
nicious forms it may also be used with benefit upon the principles 
laid down in the management of the ordinary types. 

Dengue fever is an acute, febrile, epidemic disease, characterized 
by a remitting fever, severe pains in the joints and muscles and a 
peculiar eruption. Its cause is unknown, but seems to be closely 
associated with atmospheric conditions. Its treatment by hydro- 
therapy is essentially that of malarial fever. 



214 PRACTICAL HYDROTHERAPY. 

Measles. 

Rubeola is an acute contagious disease, characterized by fever, a 
crimson, mottled, papular eruption, terminating in branny desqua- 
mation and catarrhal inflammation of the naso-broncho-pulmonary 
mucous membrane. Its origin is an unknown micro-organism, found 
mostly in the respiratory tract, having a peculiar affinity for children 
and transmitted largely through the clothes, one attack usually pre- 
venting subsequent ones. Uncomplicated cases recover, the most 
serious danger being from lung involvement. 'Measles is a simple 
disease, requiring isolation, rest in bed and protection from draughts, 
children being especially sensitive and bearing heat abstraction poorly. 
They may drink freely of demulcent drinks, flaxseed or slippery-elm 
tea, strained raspberry water, orangeade, all of which are best sweet- 
ened with saccharine. In the milder forms, where the temperature is 
not above 103° F., the sponge bath may be used at 9^° quickly done, 
avoiding friction, or the full warm bath at 98° for ten minutes re- 
peated every four or six hours. This bath may be all that is necessary, 
but where there are pulmonary complications these will be best met 
by using the full warm bath for ten minutes, followed by the affusion 
(see scarlet fever) at 80° F., reducing the latter to 70° F. This must 
be brief and care taken afterward to prevent heat abstraction. If the 
temperature remains at 103° F., use the abdominal compress or half 
pack at 70° F. between the baths. These baths should improve cough 
and induce sleep. Where cerebral complications exist (delirium, 
jactitation, convulsions) due to toxemia, use the full hot bath (110° 
to 115° F.) for ten minutes, followed by an affusion at 75° F., 
directed to the neck, chest and spine, repeating every four to six 
hours. Foreign authorities consider cold baths the more efficient 
measure, and believe that the toxemia is best combated and pulmonary 
complications more favorably influenced by their use. The pharyn- 
geal irritation is met by the throat compress, steam inhalations and 
hot alkaline gargles. Bronchial complications are so frequently 
present, and being the one serious complication, demand attention. 
In this condition use the chest compress at 80° every hour, or a cold 
sponge to chest at 60° F., twice or thrice daily. If eruption is delayed 
the hot bath is best. 

German measles are treated in the same manner. In both diseases 
medicines are rarely needed. 

Chicken Pox. 

Varicella is a mild contagious febrile affection, characterized by a 
vesicular eruption, which early dries up and falls off, and moderate 
fever. Its origin is unknown, but is presumably microbic. Its termin- 
ation is nearly always favorable. The use of the neutral bath twenty 



INFECTIOUS DISEASES— FEVERS. 215 

to thirty minutes twice daily during the eruption and tonic measures 
during convalescence are indicated. 

Whooping-Cough. 

Pertussis is an acute infectious disease, characterized by a con- 
vulsive cough, associated with catarrh of the air-passages. Its origin 
is from an unknown organism asssociated with the sputum. At- 
tacks render one immune. Isolation should be practiced, though on 
bright sunshiny days the patient may go out, care being taken to 
avoid catching cold. The nose and throat should be sprayed with 
Dobell's solution and inhalations practiced. There is no question but 
what the disease can be shortened and the patient made more com- 
fortable by the use of hydriatic measures. The dripping sheet, 
commencing at 90° and gradually reduced to 65° F. for two to three 
minutes twice daily, or the cold sponge reduced in a similar manner 
to 60° F. will enhance the child's vital resistance. These measures 
may be preceded by the neutral bath for twenty to thirty minutes, or 
by a general cleansing bath. The child should be urged to drink freely 
of plain water, as much as half to three quarters of a gallon daily. 
The water may be flavored with orange, lemon, strawberry or rasp- 
berry juice. 

Intense cough may be relieved by the use of the chest compress 
for twenty to thirty minutes, repeated every four hours. If the 
throat is irritated the throat compress should be worn. During con- 
valescence tonic measures must be continued, utilizing the dripping 
sheet as before or the electric light bath till perspiration, followed by 
the horizontal or circular rain bath at 100° to 102° F., for one to 
one and one-half minutes, reduced to 70° F. for ten seconds. Children 
can, as a rule, be induced to take this treatment nicely. I have suc- 
ceeded with children as young as five years. 

Scarlet Fever. 

An acute, self-limited, contagio-infectious disease, characterized 
by high temperatures, rapid pulse, a diffuse scarlet rash or eruption, 
terminating in desquamation, inflammation of mouth, throat, and 
frequently grave nervous phenomena. Its origin is in an undiscov- 
ered micro-organism, peculiarly virulent, long-lived, and most fre- 
quently conveyed in the scaly particles that adhere to clothes, food, 
etc., and entering by the respiratory organs. Children are peculiarly 
susceptible, though an attack usually renders one immune. The 
symptoms are too well known to mention. It is a disease so frequently 
destructive to life as to warrant the practitioner in being cautious, 
the mortality ranging from 10 to 30 per cent. It is frequently fol- 
lowed by grave sequela?. The toxic agent cannot be neutralized, 



216 PRACTICAL HYDROTHERAPY 

although antistreptococcic serum has been used with some benefit. 
The toxin must be combated by those agents that secure general vital- 
izing effects, for by increasing the vital margin the effects of the 
disease may be lessened and serious complications averted. The 
disease being self-limited, kidney and skin action must be maintained 
to remove the toxins. In grave cases the diffuse dermatitis and sup- 
pressed skin action require constant attention, and this, together with 
kidney action and support of the heart, is the tripod of essentials best 
met by hydriatic measures. Isolate the patient, keep quiet in bed and 
freely ventilate the room. Diet is liquid, principally milk. Complete 
disinfection of all articles used. During the prodromes commence 
with a calomel and soda purge and the cold sponge at 80° F., reducing 
each time three to five degrees until 60° F. is reached. Induce the 
patient to drink freely of plain, sterilized or carbonated waters, taking 
half to three-fourths of a gallon in the twenty-four hours. Keep 
mouth, nose and throat antiseptic by means of hydrogen peroxide, 
alkaline or boric acid washes. 

"In the prodromal stage of scarlatina, ere a diagnosis can be 
clearly established, and in those cases in which the eruption is im- 
perfect, with or without high temperature, the chief brunt of the 
disease is borne by the heart, as evidenced by feeble, rapid, and 
compressible pulse, mottled or cyanotic skin, and apathy. Here cold 
affusions afford most valuable resource. A full bath of 100° F., if 
the body temperature is not above this point, or of 90° F. if above it, 
will in five or ten minutes allay the nervous manifestations, con- 
vulsions, twitchings, etc. When these are accompanied by feeble 
heart action, the child should be held semi-recumbent by one at- 
tendant, while another pours two or four basinfuls of water at 60° 
or less over the head and shoulders. After he is dried and well 
rubbed, the patient is placed between blankets to aid reaction. The 
affusion may be repeated hourly if necessary, the water being reduced 
in temperature five degrees each time, and the application being 
made briefer. The change is often marvelous. The cutaneous 
congestion due to imperfect cardiac propulsion gives way to a bright- 
hued congestion, which relieves the laboring heart ; the patient falls 
into a refreshing slumber. Even if the temperature rises, sleep 
should not be interrupted unless the pulse indicates heart failure." 
(Kellogg.) 

After the eruption has become fully established we may use the 
full bath at 95° F., gradually cooled to 90° F. for five minutes, the 
temperature being reduced one or two degrees at each bath until 
80° F. is reached. Where for any reason this is impossible or 
declined, we may continue the use of the cool sponging or substitute 
the full hot bath. Commence at a neutral temperature of 94° F., 
gradually add hotter and hotter water until the little patient com- 
plains. This bath is, as a rule, peculiarly grateful to these cases, and 
is rarely objected to by members of the family, for to them it does 
not seem "to drive the rash in." 



INFECTIOUS DISEASES— FEVERS. 217 

Keep the cool turban on the head and sponge the face with cold 
water during the bath, thereby securing comfort, reflexly stimu- 
lating the heart and preventing syncope. Its duration should at the 
start be fifteen minutes and gradually increased to half an hour. 
Remove the child to warm woolen blankets, in which he is to remain 
for thirty to sixty minutes, and induce to drink freely of water. 
The author has found children to take kindly to demulcent drinks 
(slippery elm, flaxseed water) sweetened and then strained, or an 
orangeade in which a small amount of potassium citrate has been 
dissolved, not sufficient to mar the taste ; if this disagrees sweeten 
with saccharine. This will promote free diuresis, "lift the load" off 
the kidney and secure the toxic elimination so much to be desired. 
Watch the urine for albumin, blood and casts, and when this occurs 
take great care in all hydriatic procedures that the patient does not 
get chilled. It is conceded that cool sponging and baths are best in 
the earlier stages, and in the later stages the hot, because of their 
action in preventing uremic complications. In the first stages we find 
the cold sponge and baths acting as an invigorant to the nervous 
system, as an antipyretic, sedative and heart tonic, and in my opinion 
so enhancing the resistive power of the organism as to act as a pre- 
ventative of subsequent complications. They should be repeated 
four to six times daily as a rule. 

Certain clinical conditions or complications need consideration. 
Heart failure (weakness, endo- or pericarditis) is best met by means 
of the ice-bag applied to the precordia for fifteen or twenty minutes 
every two hours. Where the condition is serious, remove at end of 
fifteen minutes and apply hot fomentation for thirty seconds and re- 
apply the ice-bag. By this means the reflex effects of the ice are en- 
hanced, for when the skin becomes chilled nerve impulses are less- 
ened and the benefits that are to be derived from its use lost. In 
case of vomiting, a hot fomentation for ten minutes, repeated once, 
followed by ice-bag over stomach, will relieve. Cold carbonated water 
or small pieces of ice can be taken internally at the same time. Diar^ 
rhea is best controlled by enemata of sterile water at 80° F. after each 
evacuation. Convulsions, tremors, and other nervous manifestations 
are to be met by the use of general hydriatic measures, especially the 
full hot bath, followed by a cold coil-cap applied to the head over a 
compress of gauze. Keep bowels well open, and, if necessary, try 
the bromides. 

For the pharyngitis, tonsillitis, etc., the author's throat compress 
will be found serviceable, together with the internal use of pellets of 
ice. Steam inhalations or the use of hot gargles of alkaline water give 
much relief. 

For nephritis, urinary suppression, etc., use copious water-drinking, 
the hot full bath followed by blanket pack for one hour. This bath 



218 PRACTICAL HYDROTHERAPY 

under these conditions should be raised to 110° to 115° F., duration 
ten to fifteen minutes. Repeat every four hours. 

For convalescence institute some tonic hydriatic measure — drip- 
ping sheet, half bath, horizontal rain. etc. Precede their use by the 
electric light bath, and see that full reaction is attained. General 
roborant tonics — iron, quinia, strychnia, hypo- and glycerophosphates 
— are indicated. 

Diphtheria. 

Diphtheria is an acute specific constitutional disease, both epidemic 
and contagious, characterized by a local exudation, fever, great pros- 
tration of the vital powers, albuminuria and various paralytic se- 
quelas. Its origin is a specific micro-organism, the Klebs-Loeffier 
bacillus, the toxin of which, generated in the course of its growth, 
produces the symptoms of the disease. It grows luxuriantly on the 
secretions of the upper air-passages, and is breathed freely into the 
atmosphere, adhering to all objects, thus requiring careful disinfec- 
tion. The prognosis is always grave, the mortality running about 10 
to 12 per cent. Moderate exudate, low fever and good constitution 
are favorable. The seriousness of the disease demands that we shall 
from the start use every measure that will prevent the formation, 
eliminate the toxin and conserve the energy and strength of the pa- 
tient. Remove all objects from the room, place the patient in bed, 
and keep the room well ventilated at a temperature of 70° F., the air 
of which is rendered moist by means of a steam kettle. The diet 
liquid, milk, broth, eggs, albumen-orange solution, etc. Tincture chlo- 
ride of iron is indicated. The nose and throat should be swabbed 
with hydrogen peroxide, 50 per cent, solution, and sprayed with hot 
Dobell's solution frequently. All attendants should wear clothes of 
washable material. Carefully sterilize utensils, dejecta, etc., and cleanse 
the hands in antiseptics after each contact. To increase the vital 
strength of the patient and to prevent the loss of valuable strength, 
commence with the cold sponge at 60° F., repeating this procedure 
three or four times daily if the temperature is high. Should the tem- 
perature be subnormal, give a short full hot bath, or a hot fomenta- 
tion to the spine, followed by the cold sponge. The local condition 
is best met by the use of a hot fomentation for ten or fifteen minutes, 
followed by the cold throat compress, removing the compress fre- 
quently and repeating the fomentation every two hours, in connection 
with steam inhalation or hot-water gargles of phenol. Copious water- 
drinking of sterilized or carbonated waters. In threatened suffoca- 
tion do not try any hydriatic measure. Intubate or perform trache- 
otomy. Therapeutic nihilism and sole dependence on antitoxin has 
sacrificed lives ; utilize all measures. 

Cardiac collapse calls for hot fomentation for one-half to one 



INFECTIOUS DISEASES— FEI'ERS. 219 

minute to the precordia, followed by the ice-bag for fifteen minutes, 
constantly repeated if necessary, or in milder cases every hour. 

For the nephritis use full hot baths, commencing at a temperature 
of 100° F. and rapidly increasing to 110° F., or toleration. Keep cool 
compress or ice-bag on head, and sponge face with cold water while 
in tub. Remove to dry full pack for thirty to sixty minutes. Should 
neuritis, due to the toxins, develop, it must be treated as such. Hot 
applications are valuable during the painful stage, though this is rather 
difficult to use in palatal trouble ; inhalations and hot throat compress ; 
rest of the part until inflammation has subsided. The resulting paral- 
ysis must be treated by local electric light baths, followed by cold 
applications ; the galvanic current to stimulate muscular contractions, 
massage, gymnastics, and later the sinusoidal current 

Convalescence requires great care and watchfulness, rest in bed, 
gradual resumption of sitting and later standing posture. Continue the 
cold sponging and the use of the ice-bag to the precordia, admininster- 
ing iron, quinine and strychnia internally. Feeding is essential to com- 
bat the adynamia and anemia. Later we commence the use of the drip- 
ping sheet at 65° F. for three minutes, with good friction night and 
morning; then general roborant and reconstructive measures, such as 
electric light bath, until sweating, followed by the dripping sheet as 
above; next the half bath at 65° F. for two to five minutes, then the 
horizontal rain bath at 100° F. for one minute, followed by the same 
at 65° F. for fifteen seconds, pressure twenty pounds. 

Mumps. 

Parotitis is an acute infectious disease characterized by swelling of 
one or both of the parotid glands and other salivary glands, attended 
with fever, pain, swelling and disorder of the function of the glands. 
There is a strong tendency to metastasis to the testes and ovaries. 
Atrophy rarely follows. Its origin is a specific poison, probably mi- 
crobic, is epidemic, males suffering mostly. Prognosis is favorable. 
In simple cases the ordinary hygienic rules and measures, isolation 
and liquid diet, are all the measures that are needed. Rest must 
be insisted on as a preventive of orchitis and oophoritis. Cold water 
drinking and the use of the cold sponge at 65° to 50° F.. two or three 
times daily, will give much comfort and reduce the fever. Apply 
fomentations every two or three hours to the affected glands for ten 
minutes, remove and place over them the cold compress at 50° to 60° 
F., repeating this latter every twenty minutes, if necessary, or place 
an ice-bag over the compress. Keep this treatment up until active 
inflammation subsides. In case of orchitis, ovaritis or inflammation 
of the mammae, do not interfere too actively, but apply same treat- 
ment as to parotid gland, being careful in the male to embrace entire 
genital organs, as well as inner thighs ; in the female make applica- 



220 PRACTICAL HYDROTHERAPY. 

tions to the ovarian region or breasts. A very hot foot-bath ( 1 10° to 
120° F.) is> of value as a derivative. If pain in testicle is excruciating, 
a cold solution of lead and opium wash may be used on compress. 
Where males are well grown a suspensory is at times advisable. 

Convalescence is aided by tonic hydriatic methods enumerated 
under other heads. 

Erysipelas. 

Erysipelas is an acute specific, infectious disease, characterized by 
a peculiar inflammation of the skin, generally of the neck and face, 
with febrile reaction. It affects the lymphatic vessels and glands, 
tends to produce serous infiltration and suppuration of the areolar 
tissue. Its origin is microbic, due to the streptococcus erysipelatus, 
generally entering through some break or abrasion of the skin or mu- 
cous membranes of the nose. It is essentially a septic inflammation. 
The general indications of isolation and sterilization of clothes, etc., 
should be observed. Internally the tincture of the chloride of iron 
in large doses (10 to 30 drops) and quinine (grs. 1 to 3) every three 
hours, should be administered. Its extension is sometimes stopped 
by using tincture of iodine or solid stick nitrate of silver to the periph- 
ery of the inflammation. Antistreptococcus serum has yielded good 
results. Hydriatic measures resolve themselves into the use of those 
general roborant cold measures that will increase the margin of vital- 
ity, this being especially true in those who have been otherwise septic 
(puerperal) and in alcoholics. We may use the full cold bath or full 
cold pack, commencing at 80° F. and gradually reducing each pack 
until 65° F is reached. Duration fifteen to thirty minutes. 

The best measure, in the writer's opinion, is the cold sponge 
applied at 60° F every three hours, which will be found strengthen- 
ing, refreshing, invigorating and temperature-reducing. Local meas- 
ures are of great value. During the early stages of the disease the 
cold compress dipped in water at 50° to 60° F., containing two 
drachms of carbolic acid to the pint, should be applied to the area 
affected every fifteen to twenty minutes. Hebra has used continuous 
cold in these cases with much benefit. Ice compresses and ice-bags 
should be avoided, for fear of sloughing or gangrene. When the inflam- 
mation subsides and extension has ceased, the time of application may 
be lengthened, or a fomentation for one-half to one minute, followed 
by the cold compress, utilized. In case of vomiting, pellets of ice 
internally, the ice-bag over the stomach, or the half pack may be em- 
ployed. Free drinking of water at all times. Should nephritis de- 
velop, use the full hot bath, commencing at 96° F., gradually increas- 
ing the temperature to toleration for fifteen to thirty minutes, fol- 
lowed by the full dry blanket pack for one hour. Keep a cold turban 
on head and sponge face during bath to secure comfort and prevent 



INFECTIOUS DISEASES— FEVERS. 221 

fainting. At the start its duration should be fifteen minutes, increased 
to half an hour. 

Remove to warm woolen blankets, in which the patient should 
remain for thirty to sixty minutes, and induce to drink freely of de- 
mulcent drinks. This bath produces free diuresis, diaphoresis, and 
relieves the kidney of much work. If heart action becomes feeble, 
peri- or endocarditis develop, apply the ice-bag to the precordia for 
ten minutes every hour or two, as the case demands Delirium calls 
for the ice-bag or cold compress to the head. 

Convalescence is hastened by tonic hydriatic measures — the drip- 
ping sheet, electric light bath, followed by the horizontal rain bath, 
jet douches or half bath, the method of using being in the order 
named. 

Cerebro-Spinal Meningitis. 

Epidemic cerebro-spinal meningitis is a malignant fever, charac- 
terized by headache, vomiting, painful contractions of the muscles of 
the back of the neck, delirium, coma, and frequently an eruption 
of purpuric spots. Its origin is microbic, being due to the Weich- 
selbaum-Jager diplococcus intracellularis, or to a mixed infection; 
the pneumococcus is believed to be the cause in many instances. Bad 
hygiene, exposure, and sleeping near the ground are supposed causes. 
It is slightly contagious, its method of transmission being unknown, 
but supposed to be through the cribriform plate of the ethmoid bone. 
The complications and sequelae are numerous. The mortality varies 
in different epidemics from 20 to 75 per cent. Isolation is best, 
though not absolutely necessary. All discharges and excreta must be 
disinfected. Liquid, supportive diet, milk, soups, eggs, albumen- 
water, etc. For intense pain, morphia hypodermically ; coal tars and 
depressants must be avoided. In 1894 Aufrecht, of Magdeburg, in- 
troduced hot baths, and this has become a recognized method since 
then. The full hot bath, commencing at a temperature of 95° to 100° 
F. and rapidly increasing to a temperature tolerated by the patient, 
for fifteen to thirty minutes, followed by the warm or hot full dry 
pack, repeated three times daily, or, if necessary, every three hours, 
is unquestionably the best method. During and between the baths 
the ice-cap, cold cephalic compress or cold coil must be kept upon 
the head. The use of the long Chapman's spinal ice-bag oftentimes 
aids. 

The influence of the bath is to act as a sedative to the nervous 
system, to relax and prevent muscular spasm, relieve pain, hyper- 
esthesia, restlessness and to prevent sequelae. The skin should be 
kept constantly warm between baths in order to draw the blood from 
the brain and spinal cord. 

Goldscheider advises active movements while the patient is sub- 



222 PRACTICAL HYDROTHERAPY. 

merged in a bath of ordinary temperature. Cardiac collapse may be 
combated by the ice-bag to the precordia. Rogansky,* after five 
years' experience with Aufrecht's method (fifty-one patients) in the 
women's wards, giving the bath for fifteen to twenty minutes two 
or three times daily, says that the bath to be efficient and curative 
must be commenced before the fourth day, although its influence for 
good is pronounced even after this long a time has elapsed. A most 
remarkable result was noticed on sub-delirious patients, one bath fre- 
quently clearing them up. He gives the following interesting table: 

Number Treated. Deaths. 

First day 1 

Second day 1 

Third day 2 

Fourth day 6 1 

Fifth day .' 10 6 

Sixth day 7 2 

Seventh to twelfth day 15 5 

Sixteenth to thirtieth day 9 3 

In the men's wards, of fifty cases in the same epidemic, practi- 
cally control-cases, and treated by the "ordinary and usual methods," 
forty died, a death-rate of 80 per cent. ; death-rate of all cases by 
Aufrecht method, 33 per cent. Yarochilsky reports two recoveries 
and Yallich five cures out of seven cases. It will be noted, however, 
that where the bath method was instituted during the first four days 
the death-rate was only io per cent. The sequela? are comparatively few. 

Of late repeated lumbar puncture, with drainage of the pus, has 
been helpful, and in several cases seemed to save life, even though 
the diplococcus was present. The pus should be drawn off slowly to 
prevent too rapid a fall of pressure. 

Convalescence is tedious, and the sequelae must be met as outlined 
under other heads. As the patient improves, general tonic and robor- 
ant hydriatic measures must be used, of which the dripping sheet, 
the full wet pack, the electric light bath, followed by the half bath, 
horizontal rain and jet douche, are to be mentioned. 

Smallpox. 

Variola is an acute, epidemic, contagious disease, characterized 
by fever, severe lumbar pains and vomiting, lasting for three or four 
days and followed by an eruption, papular, later vesicular, and finally 
pustular, the pustular changes being accompanied by secondary fever 
and a tendency to the development of grave complications. Its ori- 
gin is unknown, probably microbic, possessing a virulent vitality 
for long periods. One attack renders immunity. Jenner's great dis- 
covery of the protective value of vaccination has been fully proven, 

fi Rogansky, M. : Medizinskaje Obezrenige, 1904. 



INFECTIOUS DISEASES— FEVERS. 223 

and is only rejected by rabid sentimentalists, who know not whereof 
they speak. Epoch-making, it has demonstrated that the ounce of 
prevention is better than the pound of cure, for just in proportion to 
the efficiency and thoroughness of vaccination is the rarity and mild- 
ness of variola. Its mortality ranges from 4 in the discrete, 50 in the 
confluent to 100 per cent, in the malignant. In unvaccinated per- 
sons 20 to 60 per cent. die. Smallpox comes under State control at 
present, and health boards remove cases at once to "pest-houses," 
disinfecting the premises where the case originated, a law just alike 
to the sick and those who must be protected. 

By removal we secure complete isolation, a sine qua non. The 
room should be bare of furniture and kept scrupulously clean, the 
clothes, bed-clothing, utensils, dejecta, dishes, and all objects used 
conscientiously sterilized. The patient is confined to bed in a dark- 
ened room, which should be well ventilated and kept at a temperature 
of about 65° F. The diet should consist of liquids — milk, whey, 
broths, eggs, and similar food. The white of eggs, to which orange 
juice has been added, then strained, forms an excellent food. If 
unvaccinated, this should be performed at once, in the attempt to mod- 
ify the attack. The nose and throat must be regularly sprayed with 
Dobell's solution, and the eyes irrigated with an alkaline boric acid 
solution. This should be done prior to feeding. The general treat- 
ment should aim at keeping the temperature down and favoring skin 
activity, this being best accomplished by the full bath As far back 
as 1862 Hebra, of Vienna, presented his "hammock" continuous bath 
for the treatment of variola and other conditions requiring prolonged 
immersion. Of its use Stokes (1872) says: "It is clear that in the 
case of the continuous bath we have all the conditions completely 
filled as regards the person of the patient." Where the continuous 
bath cannot be employed we may use the full bath at neutral (94° 
to 96° F.) or warm temperature (98° to 100° F.) for an hour or 
more at a time, keeping the head cool at the same time by the use of 
the cold turban frequently changed. These baths will do more to 
prevent septic infection than any other method known, being at once 
refreshing, detergent, temperature-reducing, cleansing, antiseptic and 
pain-relieving. It has been suggested to add permanganate of potash 
to this bath in weak solution. Between the baths the cold abdominal 
compress at 60° F., frequently changed. Guinon says that "in the in- 
vasion stage, with dyspnea, somnolence and a tempertaure of 104° F., 
cold full baths at 64° to 68° F. for adults and 70° to 74° F. for chil- 
dren, should be used systematically, and in sudden emergencies cold 
affusion. These cold baths do not check,' but favor eruptions and 
diuresis. The tepid and warm baths decrease pain and are cleansing." 
Internally, tincture of the chloride of iron and quinine are the best 
remedies. 



224 PRACTICAL HYDROTHERAPY. 

Certain symptoms require consideration. In the case of delayed 
eruption use hot full bath for ten to fifteen minutes, keeping a 
cold turban on head and sponging the face to prevent discomfort and 
syncope, followed by full dry pack. For laryngitis pellets of ice, 
antiseptic sprays and the throat compress. Try and prevent by an- 
ticipating it with thorough attention to nose and throat. For nausea 
and vomiting use pellets of ice, ice-bag over epigastrium, the abdom- 
inal compress, the half pack or sinapism to nape of neck. Constipa- 
tion and diarrhea are both best met by enemata at 95° F., used 
daily in the case of constipation, and irrigating the bowel after each 
movement in diarrhea. Starch and laudanum enemata are used by 
some authorities. Lumbar pain is most efficiently met by the applica- 
tion of a hot fomentation applied at intervals or by means of the hot 
half pack for thirty minutes at 110° to 120° F. if possible. For 
sleeplessness, delirium, and other cerebral complications the cold ce- 
phalic compress, the cephalic coil or cap and the ice-bag best meet 
the needs. Mild doses of the bromides may be used, but one must 
remember that the stomach is very sensitive and irritable. The ques- 
tion of pitting is one about which the relatives and friends become 
much exercised, and the horrible disfigurements that have followed 
variola justify this anxiety. Finsen, of Sweden, suggested that if 
we exclude the chemical or actinic rays — blue, violet, ultraviolet — 
we would avoid the active chemical agent, and by admitting red and 
infra-red we would have a caloric or heat ray and little chance for 
chemical action. This was further borne out by the fact that the 
chemical rays induce inflammation in the healthy skin, and for that 
reason are all the more likely to possess the power of acting injuri- 
ously upon unhealthy skin, and this seems true, as the most numerous 
and deepest scars are found on the face and hands — that is to say, 
on parts most exposed to daylight. To overcome this, Finsen sug- 
gested red window glass and curtains, but it was not an unqualified 
success ; nevertheless, it should be tried. In addition, the parts should 
be kept continually moist by compresses wet with a solution of glycer- 
ine (2 drachms ) in water (1 ounce), the compress being cut to fit 
like a mask, made of red cloth and covered with oil silk. The hands 
may be treated in the same manner. Depressing drugs should be 
avoided. 

Convalescence can be hastened by graduated tonic hydrotherapy. 
When sufficiently advanced the dripping sheet, elecfric light bath, hor- 
izontal rain or jet douche may be used as laid down in this work. 

Yellow Fever. 

"Yellow jack" is an acute infectious disease, characterized by 
high fever, yellowness of the surface, and black or coffee-ground 
vomit. Its origin is a micro-organism, the bacillus icteroides of San- 



INFECTIOUS DISEASES— FEVERS. 225 

erelli, its transmission to man being brought about by the intermediate 
agency of the mosquito, stegomyia fasciata. One attack confers 
immunity. The disease has been practically controlled in America 
by the sanitation introduced by the medical corps of the United States 
army in Cuba during the American occupation of that island. The 
mortality is high, ranging from 15 to 85 per cent. The patient should 
be placed in a bare room, closely screened, with free ventilation, and 
the air kept as near 65° F. as possible. The nurse should be an im- 
mune. Water should be drunk copiously ; hot lemonade is also valu- 
able. The conditions arise from the presence of the toxins, and every 
effort must be made to maintain warmth and favor elimination. At 
the start, for differential diagnosis, quinine should be administered 
hypodermically. W. Nelson 7 suggests the use of fifteen grains, with 
two drachms of sodium and water, given every three hours until two 
or three doses are given. If malaria, the condition clears up ; if not, 
we have to deal with yellow fever. The mixture is as follows : 

Quinia sulphat dr i. 

Ac. sulphuric dil q. s. 

Sodii sulph oz. i. 

Tr. cardamon comp oz. ss 

Aquae q. s. ad oz. viii. 

Fiat solutio. One fourth a dose. 

Nelson says : 

"The rest of the procedure was likewise born of experience; it 
was as follows : The patient was first prepared for the vapor bath. 
It can be given anywhere and in this wise : A chair with a wooden 
seat is secured. The patient is stripped and seated upon it. His feet 
are placed in a bucket of hot water, as hot as can be borne without 
burning. A spirit lamp is lit and placed under the chair. The patient 
is then covered with blankets, which are carefully tucked in to prevent 
the escape of heat or moisture. Soon in cases so treated the perspira- 
tion would show itself, rolling down the face, arms and body. The 
patient was wholly enveloped in the blankets, head only outside. In 
a few minutes the skin lost its angry scarlet hue. The pulse became 
softer and the headache less. The baths lasted ten or fifteen min- 
utes. They never were pushed to faintness. General improvement 
followed, to the great relief of the patient and his anxious friends. 
The patient next was lifted and placed on a bed, there to be enveloped 
in fresh blankets. Frequently the perspiration kept on for one or two 
hours. Later, when the skin became again dry, the pulse hard and 
the face red, the vapor bath was repeated in all its details, twice if 
necessary. Next in order, as drugs are valueless, I give patients an 
acid drink, one to be used freely, any of the mineral acids largely 
diluted. It was a grateful mixture. I let them take a half tum- 
blerful of it hourly or half hourly if the thirst was great. By this 
simple treatment two great, and, to my mind, most important indica- 
tions are met — the loaded intestines are emptied and the hot and 
burning skin is forced to act and eliminate its secretions, the system 

7 Nelson, W. : "Yellow Fever," Twentieth Century Practice of Medicine. 

xvi 



226 PRACTICAL HYDROTHERAPY. 

being relieved of the surcharged effete and fecal material. The thirst 
is incessant; water in abundance, or, better still, acidulated drinks, 
should be given. The old practice withheld water. The vomiting 
continued just the same, without it as with it. It is a most valuable 
flushing agent, to say nothing of the relief afforded to the fever- 
stricken patient. Symptoms have to be dealt with one by one. In my 
experience a temperature of 105° F. and upwards in many cases 
means delirium, sometimes violent delirium. In 1880 I commenced 
using cold applications in cases of high temperature. A tub was filled 
with large pieces of ice, towels were placed on them, and soon as 
they became wet through and cold they are placed on the patient's 
body, the arms, legs and trunk, to be renewed as soon as they become 
warm. They abstract heat rapidly, and when the temperature fell to 
104° or 104.5° F. delirium and restlessness ceased. Regarding diet, the 
patients do not want or ask for any form of nourishment. The idea 
seems wanting. While spirits and champagne have been advised, I 
fail to recognize their utility. It is needless to state that the manage- 
ment of convalescence requires a special care and constant vigilance. 
As soon as the patient rallies a little, a ravenous appetite develops. 
This is a source of great peril, and if the patient or his nurse ignores 
advice death will result. The diet must be plain, beef or chicken 
broth, free from fat, a little jelly or custard, a little Vichy or seltzer 
and milk. Plain water, Vichy or seltzer to allay thirst as soon as it 
can be tolerated, may be freely given with marked advantage. When 
admissible the juice of ripe oranges is grateful. These juices have an 
excellent effect upon a torpid liver. In due time a mild tonic of iron 
and strychnia is of value. For weeks and weeks the patient's stomach 
will be in a very sensitive state. In convalescence after severe cases 
I personally do not think that any meat should be allowed for at 
least three weeks after the crisis has been turned. As soon as the 
patient is strong enough a bath of tepid water with a little carbolic 
acid may be given. At the second bath the nurse may wash the 
patient's head and body very carefully with soap. Four or five baths 
of this nature may be given on as many days, their frequency de- 
pending upon the patient's condition. A day or two later the patient 
may be taken into a different room, well away from any draught, 
when the room, clothing and the effects that have been in the room 
can be thoroughly disinfected. As far as the mattress is concerned, 
it should be sprinkled with spirits of turpentine or coal tar, taken 
into the open and burned. The sending of the patient to a northern 
climate to complete convalescence is an excellent measure. Away 
from the hot and enervating tropics, they pull themselves together 
more rapidly. When fully restored they can return, forever immune." 

In addition to the above, the cold sponge may be utilized at such 
times as the fever rises, or may be regularly used every three or four 
hours to prevent too great increase of temperature. In case of de- 
lirium and cerebral restlessness we can employ the cold cephalic com- 
press, over which is placed the cephalic coil cap, through which cold 
water is slowly run. Gastric irritation and vomiting are helped by 
the use of the fomentation for ten or fifteen minutes every two 
hours, followed by the ice-bag. Cardiac collapse calls for free use 



INFECTIOUS DISEASES— FEVERS. 227 

of ice-bag to precordia, alternated with a short application of the 
fomentation. 

Cholera. 

Asiatic cholera is an acute, infectious disease, occurring usually 
in epidemics, characterized by vomiting and purging of a peculiar 
rice-water-like fluid, severe muscular cramps, prostration, collapse and 
death or reaction from collapse with subsequent development of a 
typhoid state. The origin is a micro-organism, the comma bacillus 
of Koch, which is found in enormous numbers in the discharges. 
Cholera is little contagious but infectious. It is usually conveyed 
by drinking-water, due to soil contamination from cholera stools. 
Flies frequently act as carriers of the contagion. It is claimed that 
the bacillus is ineffective in the intestinal canal unless persons are the 
subject of catarrhal states, and it is further known that a healthy 
stomach will destroy the bacilli. There is no immunity conferred 
by an attack. Debility, ill-health, intemperance and intestinal catarrh 
are favorite grounds for their development. In epidemics fright in- 
creases the mortality ; this fact has been utilized by Eugene Sue in 
his book, the "Wandering Jew," in the character, "'Monsieur Robin." 
Prophylaxis is the essential in those likely to be subjected to the 
contaminating influence of the bacillus, and to this end persons should 
be careful to avoid infection. This is accomplished by the use of 
none but sterilized, boiled water or milk and the eating of light, 
easily digested food. All food should be protected from contact 
with insects. All alcoholic or malt beverages, much meat and unripe 
fruit must be avoided. The Japanese have used immunizing serum, 
but it is still imperfect. Cleanliness is a most essential precaution, 
frequent bathing with warm water and soap, using a fleshbrush, 
followed by the cold shower, plunge or ablution, is one of the best 
preventatives. "With pure water, pure air, pure soil, and pure 
habits, cholera need not be feared." (Hart). Sir Thomas Watson 
says that people who use cold water daily are frequently exempt. 
The mortality, as a rule, is high, ranging from 20 to 30 per cent. 

Treatment must be instituted early. Isolate the patient in bed and 
carefully sterilize all the discharges, bed linen, knives, forks, dishes, 
etc. The nurses should be careful to wear washable garments, cover- 
ing their hair, shoes, and clothes with over-coverings that can be 
easily discarded. The hands and arms should be cleansed in anti- 
septics after each contact. The discharges must be caught in chlor- 
inated lime solution and burned. Calomel at the start, and in the 
early or diarrheal stage the "Sun" or other well-known mixtures. 
Hydrotherapy seems to offer the best method of treatment. The 
entire gastro-intestinal canal demands treatment. To meet this indi- 
cation we should have the patient at once drink as many glass fuls 



228 PRACTICAL HYDROTHERAPY. 

of hot water containing each three drops of hydrochloric acid, as 
much as six or eight being taken. The abdomen should now be 
kneaded in order to expel the liquid. In addition, enteroclysis should 
be performed, introducing the soft rubber tube far into the colon 
and irrigating with two or three gallons of hot soap and water, 
allowing same to pass out later along the tube. It was Cantani 8 who 
first suggested this method. As soon as the canal is well washed 
out introduce a large quantity of normal saline to make up for loss 
of liquids by the movements. Hypodermoclysis should be added, 
employing Cantani's solution — distilled water one quart ; chloride of 
sodium one drachm, carbonate of sodium forty-five grains ; warm to 
100.4° to 104° F. and inject one or two quarts into the subcutaneous 
tissue of the flanks. The results of this method are most striking, 
sometimes even in the algid stage; if it does not save life it at least 
gives the patient some relief from his suffering. It elevates the tem- 
perature, increases heart action, favors secretion of urine, etc. Dr. 
Elmer Lee is a champion of the method of enteroclysis, and says: 

"The plan, as finally adopted in St. Petersburg, was to take the 
patient from the ambulance to the bath-room without delay, and 
when the clothes were removed the patient was laid on his back on 
the irrigating table, with the knees drawn up and the muscles of the 
abdomen relaxed ; the long tube, after being lubricated with soap, was 
gently pushed into the rectum and urged by a twisting, gentle pressure 
into the lower bowel, as high as it could be made to go, and the 
stream of the previously prepared solution of warm water and soap, 
making a soapsuds, was allowed to run into the colon. When the 
colon became filled the pressure exerted would force the water to 
seek an outlet back through the bowel and out of the opening around 
the outer surface of tube into a properly constructed receiving-vessel. 

"After the bowels had been cleansed the patient was placed in 
a bath of warm water and afterward conducted to his bed. The 
irrigation was repeated one or more times. The average number of 
times that irrigations were given in St. Petersburg was twice ; occa- 
sionally a third irrigation was given, but frequently one irrigation 
was found sufficient. There would occur one, three or four evacu- 
ations, which would be followed by an interval of rest and cessation 
of from twelve to twenty-four or thirty-six hours. Relief of the 
spasm of the intestinal muscles, which produced the intense suffer- 
ing, followed promptly upon the removal of the irritating contents, 
and the administration of morphine was not required. In nearly 
every case the stomach was also irrigated with a solution of salt and 
water. After this combined treatment vomiting and purging in most 
cases would subside. As an internal treatment I recommended and 
used hydrogen dioxide diluted with distilled water, given in cupful 
doses at intervals of three hours, with the object of further cleansing 
and disinfecting the intestinal canal. 

"The irrigating-apparatus consists of a low table suitably made, 
as represented in the accompanying illustration. Such an apparatus 



8 Cantani. B. : Berliner klinische Wochenschrift, No. 37, 1892. 



INFECTIOUS DISEASES— FEVERS. 229 

should be provided near the homes of the poorer classes, as well as 
in every part of the city, and a physician should be detailed to 
receive and treat every person with symptoms of looseness of the 
bowels or abdominal colic. Then, if thought desirable, the patient 
should be transferred to a hospital or permitted to return home." 

The generally accepted method of external hydriatic treatment is 
that of William Winternitz and employed in German hospitals. The 
patient was enveloped standing in a cold dripping sheet and rubbed 
down until the surface of the body became warm. After three to five 
minutes' rubbing he was wrapped up in a blanket and put into a sitz 
bath at a temperature from 44° to 59° F., where he remained fifteen 
to thirty minutes, the abdomen being rubbed energetically by the 
attendants, and his extremities and such parts of his body not in the 
water protected by flannels. He was now put to bed with a compress 
wrung out of water at a temperature of 50° F. applied to the abdomen. 
By this time the patient began to perspire and feel comfortable. If 
diarrhea appeared within four to six hours the samp treatment was 
repeated, which was rarely needed. When objections were abundant 
the application was limited to rubbing with the cold dripping sheet 
well wet and the use of abdominal compresses, with an early resort to 
subcutaneous saline infusions. Inject a syringeful every minute till 
the pulse returns, then once in five minutes, and later once every 
half-hour. And not till the urine is secreted in considerable quantity 
should this procedure be stopped. 

"Clinical as well as post-mortem observations have taught us that 
the shock in the pre-algid stage is due to the rapidity of transudation 
rather than its quantity. Whatever may be its cause, the object of 
our treatment must be to strengthen the action of the heart and 
accelerate the circulation of the blood, which has become stagnant. 
For this purpose no procedure is more effective than such a thermic 
and mechanical irritation of the skin as is produced by the above- 
outlined treatment; and the greater the collapse the more urgent the 
indications for its employment." (Winternitz.) 

When cramps, a most disagreeable and distressing condition, arise 
they can be best met by rubbing the affected areas with a smooth 
piece of ice, the excruciating pain being relieved rapidly. Where 
choleraic anuria exists it is best combated by the use of hot drinks or 
the hot full bath, hypodermoclysis and hot saline injections. In the 
extreme algid stage the patient's entire body may be rubbed with 
smooth pieces of ice until the skin becomes warm, after which he 
should be removed to hot blankets. Keep warm and repeat the pro- 
cedure as often as indicated. 

Cholera Nostras. 

Cholera morbus or cholera nostras so closely resembles Asiatic 
cholera in its clinical aspects as to deserve consideration at this point. 



230 PRACTICAL HYDROTHERAPY. 

There is great difficulty in differentiating the diseases ; many authors 
believe they are identical. While the micro-orgamsm closely re- 
sembles the comma bacillus of Koch morphologically, it nevertheless 
liquefies gelatin and does not give the cholera-red reaction. The 
disease is considered to be an acute catarrhal inflammation of the 
mucous membrane of the intestinal tract, characterized by severe 
pains in the abdomen, incessant vomiting, purging, cold surface, 
muscular contractions, weak pulse and great prostration. The stools 
become rice-water-like in character, though in some cases they remain 
bilious and serous. The disease is usually seasonal, especially present 
in summer and early autumn. The mortality is about 5 per cent., 
some cases lasting only one or two days, some one or two weeks. The 
treatment is essentially that of Asiatic cholera. Prophylactic meas- 
ures, especially in diet and hygiene, are important. 

Typhus Fever. 

Spotted fever is an acute, infectious, febrile, epidemic disease, 
highly contagious, characterized by sudden onset, intense depression 
of the vital powers and peculiar maculated and petechial eruption 
and sickening odor. Its origin is supposed to be an infecting micro- 
organism, which at the present time is unknown, and which is in- 
fluenced by filth. The United States is free from the disease, which 
is rarely seen except in its sea-ports, among emigrant population. 
The prognosis is variable, the mortality running from 10 to 35 per 
cent. The contagious nature of the disease renders it imperative 
that the patient be isolated in a room devoid of carpets, hangings, 
etc. ; in fact, treatment in the open air is the best. If possible a 
nurse should be secured that is immune. The patient should be placed 
in a single bed accessible at either side and the clothing and bed linen 
frequently changed, care being taken to carefully sterilize all articles. 
The dejecta must be caught in antiseptic solutions and burned, the 
nurse at the same time taking care to protect herself by wearing 
washable clothing and sterilizing her hands and arms after each con- 
tact. The mouth should be kept clean and antiseptic, the teeth being 
washed several times daily with a brush. Dobell's solution is to be 
frequently sprayed into the nose and throat. The hydriatic manage- 
ment of this disease resembles in many respects that of typhoid fever, 
with the exception that the measures adopted should be less refriger- 
ant. To this end the use of the cold sponge is a very valuable 
measure, as is the full cold bath at a temperature ranging from 90° 
to 80° F. Friction should be maintained during this bath, and the 
patient's head carefully protected by means of the cold turban or ice- 
cap during its application. The prolonged neutral bath once or twice 
daily has been suggested in this disease. The cold full pack, repeated 



INFECTIOUS DISEASES— FEVERS. 231 

every three hours, may be used in place of the full cold bath. This 
bath has one decided advantage in that it tends to prevent the ner- 
vous complications so often present in this disease ; in fact, insomnia, 
cerebral congestion, headache and delirium are best met by the com- 
bination of the prolonged neutral bath, with application of the cold 
cephalic compress with the cooling coil-cap. Outside of the hydriatic 
measures and general hygienic management of the case little else need 
be done. The effect of the bath is to promote the action of the skin, 
abstract heat, stimulate the liver and destroy toxins, incease diuresis, 
lessen cellular disintegration, favor antisepsis, calm and tone the heart 
and nervous system and increase phagocytic action. 

Montana Spotted Fever. 

In 1902 Wilson and Chowing and later Ashburn, 9 called atten- 
tion to this febrile disease, which had been noted by local observers 
in the Bitter Root Valley, Montana ; the Snake River Valley in Idaho, 
Quinn River in Nevada and certain parts of Wyoming. These ob- 
servers found that it was parasitic in origin and transmitted by in- 
sects. In its clinical aspects this fever partakes of certain features 
of typhus fever, and at times epidemic cerebro-spinal meningitis. It, 
however, is not contagious, and the nerve symptoms are much lighter 
than those of the last-named disease. It is seasonal, occurring al- 
most exclusively in the spring and early summer, following an incu- 
bation period of three to ten days. The onset may be by chill or 
chilly sensation, headache, bone and muscle pains and nausea, to 
which later may be added nose-bleed and slight bronchitis. The 
fever gradually rises, with evening exacerbations, and reaches its 
maximum from the eighth to the twelfth day, when the evening tem- 
perature may register 105° or even 107° F. It remains high in fatal 
cases, and in favorable ones falls by lysis. ' The eruption is charac- 
teristic, appears in most cases about the third day, first on the wrists, 
arms and legs, later on the forehead, back and chest, and last on the 
abdomen. The eruption commences as bright red macules, changing 
to a purplish hue, and finally becoming definite petechias The patho- 
logical changes in the internal organs are those parenchymatous con- 
ditions usually found in febrile states. 

Ashburn 10 has found in this disease that the Brand treatment of 
typhoid fever, together with occasional infusions of normal salt solu- 
tion, is the best method. Each patient presenting a temperature of 
102.5° F. is placed in the full bath at 70° F. for ten to twenty min- 
ntes, constant friction being applied to the body and limbs, and simul- 
taneous cold applications are made to the head. The bath should be 
followed by feeding, quiet, rest in bed, and, if necessary, hot-water 

9 Journal American Medical Association, May 27, 1905, p. 1686 
10 The Lancet-Clinic, Vol. LIV, No. 17. 



232 PRACTICAL HYDROTHERAPY. 

bottles to the feet. Ashburn calls attention to the fact that all the 
precautions required in the administration of the full bath in typhoid 
fever must be followed in treating these cases, especial care being 
exercised to constantly use friction. He finds that it is most effective 
upon the circulation, and through this channel secondarily influences 
the skin, kidneys, lungs, nervous system and temperature. The baths 
should be give at fairly regular internals. Success has resulted from 
this treatment. 



CHAPTER XII. 
DISEASES OF THE STOMACH AND INTESTINAL TRACT. 

Acute Gastritis. 

Acute gastritis is an acute catarrhal inflammation of the mucous 
membrane of the stomach. It originates most frequently from indi- 
gestible food, alcoholic beverages, infectious fevers, irritating medi- 
cines and corrosive poisons. The prognosis is variable, depending 
upon the cause; it is frequently followed by the chronic form. In 
its treatment the first essential is rest; to secure this rest the patient 
must be put to bed and all food withheld, if necessary, for several 
days. Small pieces of cracked or shaved ice may be given. Unless 
absolutely necessary, do not administer morphine. With an improve- 
ment of the condition, we may commence with clam broth, fresh milk, 
Eskay's food, meat juices, and in a few days light diet, gradually in- 
creased to the normal. Hydrotherapy is the most satisfactory of all 
treatments. The best method is that of the hot fomentation, applied 
fifteen to twenty minutes over the stomach and bowels, followed by 
the abdominal compress at 60° ; repeat every two or three hours ; this 
will frequently give immediate relief. To this may be added the hot 
foot-bath at 110° to 115° F. for fifteen minutes. Another method is 
to use the hot foot-bath followed by the hot half pack for one hour ; 
it is also an excelllent method. I have seen undoubted benefit from 
the internal administration of hot water. Winternitz has had much 
successs with the use of the cold compress frequently repeated. Where 
the nausea does not yield to this treatment, we may apply the hot 
fomentation to the epigastrium, followed by the ice-bag over the 
stomach or to the spine opposite. In two of my cases magical relief 
has been given by careful lavage with very hot water. The pain is 
best relieved by the hot fomentation and compress frequently re- 
peated, in conjunction with hot water or lavage. In infants or young 
children the use of one-sixth of a grain of calomel placed upon the 
tongue dry, repeated until six doses are given, will frequently aid in 
recovery. 

Chronic Gastritis. 

Chronic gastritis is a chronic catarrhal inflammation of the stom- 
ach, with thickening of its coats and some atrophy of the glandular 
structures. It originates frequently from previous attacks or from 
the use of alcoholic liquors and cold beers. Unsuitable, irritating 
(233) 



234 PRACTICAL HYDROTHERAPY. 

and improperly cooked food, poorly masticated and insalivated, to- 
gether with irregularity in meals and overeating, has been in my ex- 
perience, the most frequent cause. Many infectious diseases, dis- 
eases of other organs, and the overuse of tobacco may be noted. The 
prognosis is good in those cases that have not reached the atrophic 
stage ; even these can be ameliorated. Prevention is better than cure. 
These cases should avoid fatty, saccharine, starchy and highly seasoned 
food, under which head would come mustard, pepper, vinegar, strong 
acids, preserves, cheese, alcoholic beverages, tea, coffee, coarse vege- 
tables, pickles and confectionery. The diet should be plain and con- 
sist of lean tender meats, finely divided, beef, mutton, sweetbread, 
chicken and squab, calf's foot and pig's head jelly, eggs, milk (if 
borne), purees of vegetables, rice, cereals (well cooked), spinach, 
celery, mashed French peas, apples, boiled, baked and mashed pota- 
toes, cream, butter, toast, zwieback. Plain water, milk, and cereal 
coffees may be used. All food must be well chewed before swallow- 
ing. Mental and physical rest, freedom from business and work are 
advantageous. The clothing should be such as will protect the abdo- 
men from being chilled. Rest should be taken before and after a 
meal. 

Hydrotherapy is one of the most satisfactory factors in the 
treatment of this disease. Lavage in the morning, half an hour be- 
fore breakfast, the water containing bicarbonate of soda. If the 
stomach is unirritated, cool or cold water may be employed; if irri- 
tated, hot water. The intragastric douche of hot water, followed by 
cold, has proved very satisfactory in my hands. Where lavage can- 
not be practiced, hot water, half to one pint, sipped an hour before 
meals. The temperature should range between 110° and 150° F., a 
pint to contain five grains each of calcium chloride and sodium chlo- 
ride. Commence with mild measures, such as the hot-air bath or the 
electric light bath, until the patient just perspires. Follow this by the 
wet sheet at 70° F. for three minutes, with vigorous friction, reduced 
three degrees daily until 60° F. is reached. At this point continue the 
electric light bath until the patient perspires, following same by the 
horizontal rain or circular douche at 102° to 104° F. for one to one 
and a half minutes, followed by the fan douche to the body and 
the jet douche to the spine and legs for one-fourth minute each, 
under fifteen pounds presssure, commencing at a temperature of 70° 
F.. reducing two degrees daily until 60° is reached, and increasing 
the pressure until thirty pounds is registered. This latter has in my 
hands proved by far the most certain and satisfactory means of 
treatment for these cases. Where we have to deal with much pain, 
the Scottish fan douche to the abdomen, gradually raising the tem- 
perature of the hot water, lowering the temperature of the cold and 
increasing the pressure, will oftentimes give satisfactory relief. Com- 



DISEASES OF STOMACH AND INTESTINES. 235 

mence the douche at a temperature of 100° F. for one-half minute, 
reduced to 70° F. for ten seconds, alternating four times ; gradually 
increase the hot water to 108° or 110° F. and reduce the cold water 
to 60° F. 

Where there is much vomiting of mucus in the morning, one may 
employ the abdominal compress or Neptune's girdle during the night. 
Where the vomiting takes place immediately after eating, rest in 
bed with an abdominal compress worn for two hours, or Chapman's 
ice-bag over the dorsal region of the spine, should be utilized. Win- 
ternitz has found the use of the cold compress and cold sitz bath very 
beneficial in these cases, but the writer's experience has been that 
the above-suggested treatment does better. For the constipation that 
so frequently accompanies the disease, enemata and the Scottish 
douche as above described applied to the abdomen, will aid in its 
relief. 

It is my custom in these cases to also use general massage for its 
tonic, nutritional and circulatory advantages. In those cases in which 
atonic states exist, local massage of the abdomen two hours after a 
meal is indicated. Exercise always helps. Rowing, pulley-weight 
movements and general gymnastics, having for their object the exer- 
cise and movement of the trunk muscles, tend to develop a much- 
needed muscular condition of the abdomen, lacking in these cases. In 
like manner gastro-intestinal and abdominal muscular development 
may be rapidly brought about by the use of the faradic current ex- 
ternally and the slowly alternating sinusoidal current, one pole in the 
rectum, the other applied to the abdominal muscles. Intragastric 
faradization acts in the same manner, developing both stomach and 
intestinal muscle power. 

Gastric Atony; Dilatation; Intestinal Atony. 

By gastric atony is meant that condition of the stomach ( or stom- 
ach and intestine) characterized by a weak, flabby condition of the 
muscular apparatus, the result of which is to retain the food too long 
within its walls. Various secretory and chemical disturbances of the 
gastric (or intestinal) juices may accompany the condition. It is 
closely allied to dilatation, and may be the primary stage, the differ- 
ence being that in dilatation stretching has actually taken place — 
that is to say, non-obstructive dilatation. Atony and dilatation bear 
a close relation to the muscular power of the intestinal abdominal 
wall. This is necessary to bear in mind, for some cases are unques- 
tionably due to this factor alone. The origin of these conditions lies 
in those unhygienic conditions, the result of modern strenuous, high- 
pressure life, causing meals to be eaten too hastily, accompanied by 
over-eating, deficient mastication, excesses in vino, in venery, in work, 
neurasthenia, or any condition that lowers vitality. In addition, in 



236 PRACTICAL HYDROTHERAPY. 

women, the corset, tight waist-bands, heavy skirts and the inexorable 
dictates of fashion increase the number of victims. The diet should 
consist of milk, cream, butter, eggs, toast, partly dextrinized products 
like shreded wheat biscuit, "Force," grape nuts, etc., purees of vege- 
tables, plasmon, beef-juice, finely minced lean meats, rice, corn meal, 
hominy, ripe seedless fruits and one glass of liquid with each meal. 

Hydrotherapy is of the greatest benefit to these people ; in fact, 
there is no treatment which compares with it. The cold tonic pro- 
cedures that should be used to invigorate, increase appetite, stimu- 
late the muscular fiber of the stomach, intestine and abdominal wall, 
and exert an influence upon the nervous system, are incomparably 
superior to any other treatment. Lavage may be indicated, but the 
intragastric douche of hot and then cold water — that is to say, a Scot- 
tish douche — internally to the mucous membrane of the stomach 
three times weekly, on arising, will develop contractile power to no 
small extent. Where the patients are weak and greatly debilitated, 
we may commence the general treatment by the full dry pack for one 
hour, followed by the cold sponge. The dry hot pack may be fol- 
lowed with the salt rub if preferred, care being taken not to apply 
too vigorous friction, it in its turn being followed by a very rapid cold 
sponge. Another valuable method of treatment is to administer the 
dripping sheet at 70° for three minutes, with vigorous friction, re- 
ducing two degrees daily until 60° F. is reached, followed by the cold 
sitz bath at 70° for three to ten minutes. As soon as able, the hot-air 
bath, or, what is preferable, the incandescent electric light bath, to 
the point of perspiration, followed by the dripping sheet at 70° for 
three minutes, reducing two degrees daily until 60° F. is reached. 
As soon as this has developed the reactive power of the patient, we 
may continue the electric light bath until perspiration takes place, 
then the circular or horizontal rain bath at 102° to 104° F. for one 
and one-half minutes, followed by the fan douche to the body and 
the jet douche to the spine and legs. Commence the douches at a 
temperature of 70° F. and reduce one degree daily until 60° F. is 
reached. The pressure should start at fifteen or twenty pounds and 
gradually be increased to thirty as the temperature is lowered. 

If epigastric pain or gaseous distension of the abdomen is 
present, the Scottish fan douche will prove most effective in its re- 
lief, as well as assist in overcoming constipation. Use as follows: 
Electric light bath to perspiration; fan douche at 104° to body; Scot- 
tish fan douche, 104° to 110° F., for twenty seconds to abdominal 
walls, changed to 60° F. for five to ten seconds, alternating four 
times; finish with jet douche to spine and back of legs at 60° F. for 
five to ten seconds. 

By the combined use of the methods herein suggested I have seen 
these miserable humans rejuvenate, take courage again and regain 



DISEASES OF STOMACH AND INTESTINES. 237 

strength, their depression leave, and life's way become once more 
lighted by the sunshine of hope. 

Splanchnoptosis. 

Splanchnoptosis, or Glenard's disease, is a generic term indicating 
a downward displacement of one or more of the abdominal viscera. 
It includes gastroptosis, enteroptosis, nephroptosis, etc. ; it may be 
one or all ; they are often coexistent. Its origin is most frequently 
to be found in a weakening of the abdominal muscles, a loss of ab- 
dominal tone, with a co-operating mechanical cause that increases the 
disability, especially corsets and heavy skirts. Trauma is a frequent 
cause. In this, as in many other diseases, the vital unit has a great 
influence upon its inception. Unhygienic and muscular-weakening 
influences, the result of the present-day strenuous methods of life, 
with its ever-present neurasthenoid and debilitating influences, has 
much to do with bringing about the condition. Its cure is brought 
about by an increased strengthening of the general neuro-muscular 
system and a special developing of the abdominal muscle, together 
with deposition of fat. Support to the prolapsed viscera is necessary, 
and to this end a well-fitting abdominal belt or supporter should be 
adjusted. It has been the writer's experience that while patients are 
taking hydrotherapeutic and mechanical treatment it is best to wear 
the belt, although in some instances he has seen much greater good 
derived from Rose's method of support by means of adhesive plaster. 
The diet should depend on the functional and motor power of the 
stomach and the condition of the intestine. Plain nutritious food, 
tender meats, fish, game, eggs, well-cooked cereals, purees of vegeta- 
bles, moderate use of sweets, fruits, milk and cereal coffees, should 
be allowed. With the regulation of hygiene we may commence the 
use of the hot-air bath, or, what is better, the electric light bath, to 
the point of perspiration, followed by the dripping sheet, with friction 
for three minutes, commencing at a temperature of 70° F. and re- 
ducing two degrees daily until 60° F. is reached. At this point we 
may change to more active treatment ; continue the electric light bath 
until perspiration takes place, followed by the circular or horizontal 
rain bath at 102° to 104° F. for one minute, pressure twenty pounds, 
reducing the temperature two degrees daily until 60° has been reached 
and gradually raising the pressure one pound daily until thirty pounds 
is recorded. We may now safely move to the strongest treatment — 
electric light bath until perspiration takes place, this to be followed 
by the circular rain bath at 104° F. for one and one-half minutes. 
Finish the treatment by giving the fan douche to the entire body, es- 
pecially the abdomen, and jet douche to the spine at a temperature of 
70°, pressure fifteen pounds. Lower the temperature one degree 
daily until 60° F. is reached and increase pressure two pounds daily 



238 PRACTICAL HYDROTHERAPY. 

until twenty or thirty pounds is recorded. Some writers, notably 
Kellogg, prefer to finish the treatment with the cold plantar douche, 
believing that this materially assists. 

In those cases that are very weak and much run down the insti- 
tution of a rest-cure and fattening should be adopted, for which see 
"Neurasthenia and Hysteria." 

Electricity is of unquestioned value, the author having found the 
high-tension faradic applied to the spine and muscles of the abdomen 
especially valuable. The sinusoidal current, slowly alternated, one 
pole in the rectum, the other applied upon the abdomen, in sufficient 
strength to produce muscular contractions, tones up those structures 
that are especially deficient. In these cases abdominal massage holds 
a prominent place. It should be administered daily with general 
massage, or may be given immediately after the hydrotherapeutic 
treatment. Special exercises which have for their object the contrac- 
tion and movement of the central and lateral abdominal and trunk 
muscles, will prove of valuable assistance. Upon recovery, where it 
is deemed necessary to certainly keep the viscera in place, Rose's 
bandage may be applied. Care in sitting and walking should be ex- 
ercised by these patients, a proper upright position being at all times 
assumed. Where this treatment is followed out persistently most 
excellent results will be obtained and surgical interference may be 
unnecessary. 

States of Hypersecretion — Hyperchlorhydria ; Reichmann's Disease; 
Chronic Sthenic Gastritis; Gastro-Succorrhea; Hyperchylia. 

Under this head we will consider those states in which the hydro- 
chloric acid or the gastric juice itself is increased. The background 
of these troubles has, in my observation, always been that of a per- 
turbed nervous system, and I am of the opinion that the increased 
secretion of hydrochloric acid is largely the result of the nervous con- 
dition. This should be most diligently sought for in each and every 
case; and, as far as possible, worries, overexcitement, business cares 
and the strains of life eliminated. The diet must not contain irritating 
food, such as condiments, salt, pepper, sauces, vinegars, etc. ; albu- 
minoids should be restricted, and milk, eggs, well-cooked cereals, 
toast, zwieback, butter, moderate amount of fats, vegetables as 
purees ; potatoes, baked, boiled or mashed, with butter, cream and 
milk, macaroni, spaghetti, spinach, baked sweet apples, ripe peaches, 
pears, oranges, bananas and white grapes taken. Meats once daily, 
the lean parts finely divided, hamburger steak without seasoning, fish, 
chicken, turkey, etc. As beverages, water, Vichy, seltzer, Apollinaris 
and cereal coffees may be used. Plenty of sleep must be secured and 
moderate fresh-air exercise indulged in. Golf is especially valuable in 
these conditions, though horseback riding and driving may be utilized. 



DISEASES OF STOMACH AND INTESTINES. 21) 

Hydrotherapeutics are valuable, and alone are sufficient to cure the 
disease. We can commence by using the hot fomentation an hour 
before meals in conjunction with the other methods to be hereinafter 
mentioned. Where recourse cannot be had to institutional treatments, 
we may employ the hot full bath at 105° F. for ten minutes, followed 
by a rapid cold sponge, care being taken to keep the head cool during 
its application. Another satisfactory method, strongly endorsed by 
European authority, is the use of the cold sitz bath at 60° to 50° F. 
for five to ten minutes, followed by the stimulating abdominal com- 
press. 

Institutional treatment offers the most satisfactory method for 
these cases. Commence with the hot air bath, or, what is better, the 
incandescent electric light bath, to the point of perspiration, followed 
by the use of the dripping sheet, with friction, at a temperature of 70° 
for three minutes, repeated daily, lowering the temperature two de- 
grees until 60° is -reached. At this point we should change the 
treatment ; continue the use of the electric light bath or hot air 
until free perspiration, followed by the circular or horizontal rain 
bath at a temperature of 102° to 104° F. for one and one-half min- 
utes; follow this by the fan douche to the body ten to fifteen sec- 
onds and jet douche to the lower limbs ten to fifteen seconds, at a 
temperature of 70° F., pressure twenty pounds. Reduce temperature 
of douches two degrees daily to 60° F., increasing pressure two pounds 
until thirty pounds is reached. We may, if we choose, on alternate 
days substitute the salt rub or glow for the electric light bath, although 
the writer has found the preceding application much more satisfac- 
tory. From some experimental work upon the value of these treat- 
ments in states of hypersecretion, the writer feels warranted in stating 
that these alone are sufficient to bring about a cure, but in conjunction 
with them certain auxiliary methods will decidedly help. 

Intragastric faradization with a high-tension fine-wire coil, as sug- 
gested by Reed, has proved of benefit in checking the secretion of gas- 
tric juice, applied three times weekly. General massage, avoiding the 
abdomen, will be found a satisfactory alternate with intragastric farad- 
ization. Medicinal treatment is unsatisfactory, although the judicious 
and careful use of diastatic preparations, especially "Takadiastase," 
and the alkalies have given relief. The bromides sometimes help. 

Gastric Ulcer; Duodenal Ulcer. 

Gastric ulcer is a circumscribed solution of continuity involving 
the mucous membrane and one or more layers of the stomach walls, 
characterized by pain, hyperchlorhydria, disorders of digestion and 
vomiting of blood. Gastric ulcer is comparatively rare, but originates 
most frequently from the corroding action of an excessively strong 



240 PRACTICAL HYDROTHERAPY. 

gastric juice rich in hydrochloric acid, and occurs especially where 
the patient is the subject of marked anemia or chlorosis. Some ulcer- 
ations occur in the duodenum, especially following extensive super- 
ficial burns of the cutaneous surface. The auto-digestion of the 
mucous membrane occurs when the vitality is low, and where this 
condition is coupled with hyperchlorhydria one should always suspect 
gastric ulcer. The powerful tonic, restorative and corrective power 
of hydrotherapy over these conditions make it the treatment par ex- 
cellence, acting as it does in removing causal factors and relieving 
present conditions. The treatment should have for its object the com- 
plete rest of the stomach, to modify the gastric secretion and restore 
the vital resistance. Absolute rest in bed for three to six weeks is 
essential, and for the first two or three weeks rectal feeding three 
times daily is necessary. This should be preceded by the normal 
saline solution, and the nutritive enema may consist of milk four 
ounces, two eggs well beaten up, a pinch of salt, all predigested by 
pancreatin. Reed suggests the use of milk, freshly expressed meat 
juice, meat powders, beef juice, raw eggs, solution of sugar, butter or 
olive oil, and well cooked solutions of starch. Ewald's plan is to use 
two or three eggs beaten up with a tablespoonful of cold water; a 
tablespoon ful of prepared cereal, dextrinized by heat, is boiled with 
half a tumbler of a 20 per cent, solution of grape sugar, and a wine- 
glassful of claret added. When lukewarm, stir in the eggs and add 
fifteen grains of salt. Return to feeding may begin with milk and 
lime water, equal parts ; milk, lime water, barley water, equal parts ; 
then, as judgment suggests, soft-boiled or poached egg, calf's-foot 
jelly, purees of vegetables strained, so that by the end of six weeks 
well-cooked cereals, "Force," grape nuts, cream of wheat, stale bread, 
butter, etc., are in the dietary. For months the patient must avoid alco- 
hol, beers, wines, tobacco, condiments, acids, vinegars, excess of salt, 
hard food and coarse vegetables. The hydrotherapeutic treatment of 
this trouble should consist of measures that relieve the pain, lessen 
the formation of hydrochloric acid and diminish gastric activity. This 
is test accomplished by the use of the hot fomentation for fifteen to 
twenty minutes, followed by the hot abdominal compress, well cov- 
ered with flannel, over which may be placed oil silk. The flannel must 
be wrapped around the body in such a way as to prevent the loss of 
heat. 

Sadger* believes in powerful stimulating general and local meas- 
ures. He finds that the abdominal pack at 60° F., changed every four 
hours, in conjunction with a coil inserted in the pack once or twice a 
day, and through which water at 104° F. (40° C.) is allowed to flow, an 
excellent measure. As soon as possible he adds to this a sitz bath at 
46° to 55° F. for three to five minutes once daily. In the morning a 

1 Berliner klinische Wochenschrift, April 14, 1906. 



DISEASES OF STOMACH AND INTESTINES. 241 

rapid cold sponge is given, avoiding chest and abdomen. A good 
arrangement for home use is a cold pack until the sheet gets warm 
(twenty to thirty minutes), with a half bath afterward at 22° or 20° 
C. (68° F. ) for two or three minutes. Milk is the only food he al- 
lows for four or five weeks, commencing with a teaspoon ful every 
fifteen minutes. He increases the amount to a tablespoon ful, then to 
half an after-dinner coffeecupful, and finally to a teacupful, lengthen- 
ing the intervals to thirty to sixty minutes. He insists on this diet 
after acute hemorrhage, and also in the treatment of chronic ulcer. 
Even on the day of the hemorrhage it is possible to commence with 
minimal amounts of the milk (ice cold). The milk must always be 
very slowly sipped. 

By these methods much good may be acccomplished in conjunc- 
tion with the dietetic, hygienic and medicinal treatment of the dis- 
ease. In hemorrhage no ice or cold drinks must be taken into the 
stomach, as they will actually favor hemorrhage when the water ac- 
cumulates and becomes warm. A cold compress should be placed 
over the stomach, and upon this the cold coil or ice-bag (not too 
heavy) may be laid, keeping same up for a week. 

States of Hyposecretion — Hypochlorhydria ; Achlorhydria ; An- 
acidity; Hypochylia; Achylia Gastrica; Hypopepsia; Apepsia. 

Under this head we embrace those conditions marked by the dimi- 
nution or absence of hydrochloric acid in the gastric juice. It must be 
borne in mind that there are numbers of instances in which the dimi- 
nution or absence of the hydrochloric content is not due to the condi- 
tions we are here discussing, being brought about by such diseases as 
asthenic gastritis, amyloid degeneration, atrophy, carcinoma, etc. It 
is not intended to otherwise than convey the idea of a condition of 
suppression or absence, generally of a nervous or neurotic origin, 
and not dependent upon organic structural lesions, consequent upon 
or sequential to other disease. The writer has seen quite a number 
of achlor- and hypochlorhydric cases, although they form a small 
class in his experience compared to the hyperchlorhydric group. They 
are usually constructed upon a neurotic, neurasthenic or devitalized 
basis. Hygienic errors, absence of fresh air, mental worry and strain, 
loss of sleep, digestive errors and indiscretion, all lead to its produc- 
tion. In passing, we may say that the treatment, to be successful, 
must be continued over a lengthy period. The patient should avoid 
all rich foods, gravies, much meats, pickles, cane sugars and confec- 
tions. Every effort should be made to preserve and stimulate the 
secretion of hydrochloric acid. Hydrotherapy alone is sufficient to 
bring this about, its value having been fully determined by me in a 
number of cases carefully studied with this in view. Where there is 
any tendency to weak muscular power and stagnation of the gastric 



242 PRACTICAL HYDROTHERAPY 

contents we must have recourse to lavage. After cleansing the stom- 
ach, several washes should be made with hot water, followed by cold 
water, thus subjecting the mucous membrane of the stomach to the 
influence of the Scottish douche. To stimulate appetite and the flow 
of gastric juice, drink half a glass of cold water one hour before meals 
and put an ice-bag over the stomach for an hour before eating. Gen- 
eral hydrotherapeutic methods are most valuable, as they tone up the 
relaxed musculature, increase secretions generally, and improve nerve 
force. Commence with the electric light bath or hot-air bath until 
perspiration. This may be followed by the dripping sheet with fric- 
tion at a temperature of 70° F. for three minutes, lowered two de- 
grees daily until 60° F. is reached. Reaction must be secured. As 
soon as established we should commence with the electric light bath 
or hot air until perspiration, followed by the salt rub with sufficient 
friction to redden the skin, followed by the horizontal or circular rain 
bath at 104° F. for one and one-half minutes, reduced to 80° F., under 
twenty pounds pressure ; reduce two to three degrees daily until 60° 
F. is reached and raise the pressure two pounds daily to thirty pounds. 
When this point is reached we may now follow the rain bath by the 
fan douche applied to the body for five to ten seconds, and the 
jet douche to the spine for five to ten seconds, at a temperature 
of 60° F., thirty pounds pressure. Especial pains should be taken to 
have the jet strong in the dorsal region opposite the stomach. As 
soon as the improvement is marked the following hydriatic treatment 
should succeed the others: The daily use of the electric light bath or 
hot-air bath to perspiration ; horizontal rain bath at 104° F. for one 
and one-half minutes; the fan douche to the entire body for one- 
fourth minute ; the jet douche to the spine one-third minute and to 
the abdominal wall for one-fourth minute, at a temperature of 60° 
F., under a pressure of twenty or twenty-five pounds. It is sometimes 
marvelous to contemplate the changes that will take place under the 
powerful, stimulating and perturbating influence of this treatment. 
Cases that were apparently hopeless take on new life and vigor, and 
respond to the treatment with a reaction to which they had been 
strangers for many years. 

Auxiliary treatment I have found of considerable value, especially 
central galvanization, the large negative pad being applied over the 
abdominal sympathetic, the positive over the cervical. The static 
wave current (Snow), using a large block-tin pad applied over the 
abdomen, is a valuable treatment. Manual massage and mechanical 
vibration in connection with the slowly alternated sinusoidal current 
will aid hydrotherapy in rapidly toning up the local structures of the 
abdominal wall of stomach and intestines, increasing secretion, favor- 
ing elimination and overcoming constipation. 

These cases should be urged, where it is possible, to indulge in 



DISEASES OF STOMACH AND INTESTINES. 243 

swimming after they have been relieved of the disease. Surf bathing 
offers probably the best post-treatment we have, comoining as it does 
fresh air, exercise and the stimulating percussory influence of the saline 
water upon the skin. The duration of an immersion in the surf should 
be brief, followed by a rub down and short walk. 

Acute Intestinal Catarrh; Acute Enteritis; Acute Entero-Colitis ; 

Acute Gastro-Entero-Colitis of Children; Cholera Infantum; 

Summer Diarrhea; Summer Complaint; Acute Diarrhea. 

The above states are due to acute inflammations of the mucous 
membrane lining the intestinal tube, characterized by pain, tenderness 
and loosenesss of the bowels ; in some fever is present. There is no 
question but that in a great many cases the disease is due to the pres- 
ence of micro-organisms, which have been ingested and multiplied in 
the intestinal canal. In others, ptomaines, offensive and irritating 
food and exposure are the determining factors. In all, the first ele- 
ment should be the prompt removal of the offending mass ; if the case 
is vomiting, wash out the stomach with hot water, followed by the 
ice-bag to the external surface. The copious drinking of hot water 
is indicated ; this should be administered in teaspoonful doses and in 
small children by nursing bottle. All food must be withdrawn. Where 
calomel is indicated this may be administered as a dry powder upon 
the tongue in one-sixth to one-fourth grain doses, repeated every 
thirty minutes until a grain or two have been taken. The bowels 
should be immediately and thoroughly emptied by means of a hot 
saline enema, temperature 105° to 110° F., and repeated at least twice 
daily as needed. By this means the calomel will cleanse the small in- 
testine, and the enema, by irrigating the colon, removes the mucus, 
bacteria, fermenting material and food. The absolute abstention from 
food neutralizes the efficiency of germ life, removes its nutrient me- 
dium and reduces intestinal activity to a minimum. In the cases oc- 
curring in children, the hot full pack, until hyperemia of the skin takes 
place, followed by the cold sponge rapidly performed, is indicated. 
If fever is high, use the wet pack at 70° F., reduced each time two 
degrees until 60° F. is reached, at which temperature it is to be main- 
tained. It should be repeated every three hours if necessary, its rep- 
etition being regulated by the general condition and fever. In adults 
the cold sitz bath (70° to 50° F.), ten to thirty minutes' duration, 
is a valuable method, and the author can speak in unmeasured terms 
in its praise, it having in his hands yielded some brilliant results. Its 
action is to lessen peristalsis and produce an anemia of the mucous 
membrane. In a member of his own family this measure has accom- 
plished, in acute exacerbations and chronic states, results most prompt 
and satisfactory. There are cases in which appear nervous collapse, 
prostration and inanition, and in whom shock is well marked, due to 



244 PRACTICAL HYDROTHERAPY. 

the diarrhea and absorption of ptomaines ; in these cases the nervous 
system is profoundly involved, showing apathy, pallor and cold extrem- 
ities. They present many of the symptoms of the so-called "typhoidal 
state." The indication is the full bath at 90° F. for seven to ten min- 
utes, repeated two or three times daily. Do not be swerved from the 
procedure by any cry or protest ; be kind, but firm. The friction should 
be gentle, the patient removed to the sheet, covered and packed with 
blankets. The remarks made covering typhoid fever bear on these 
cases with this distinction and difference, that in intestinal troubles a 
more decided reaction must be sought. 

"The object of this bath is not alone to reduce temperature, al- 
though this is an important incidental result. We have here a vaso- 
motor paralysis, as evidenced by the pallor of the entire body, even 
when a high temperature is registered in the rectum. By immersing 
the entire body in tepid water we produce a mild cutaneous excitation, 
which is gradually increased by the removal of warmth and the addi- 
tion of cold water, and is enhanced by frictions of the body and con- 
stant agitation of the cooling water against the skin. These gentle 
shocks are not beyond the child's reactive capacity ; they are suc- 
ceeded by equally gentle reactions, so that the cutaneous vessels dilate, 
as evidenced by redness of the skin. If, in addition, the face and head 
are bathed with water at 60° F. or below, the shock and reaction are 
increased, the respiration deepens, and the heart beats with more 
vigor and less rapidity, the eye brightens, the color returns to the 
lips, the child becomes more animated." ( Baruch. ) 

The bath may be preceded by a draught of hot water and the 
dry full pack where fever does not exist. Should collapse supervene 
at any time, the hot full dry pack, hot-water drinking and the ice-bag 
to the precordia will be found most useful. The return to food must 
be along the line of sterile, pasteurized milk, graduated diet, etc. 

Acute Dysentery; "Bloody Flux"; Acute Colitis; Acute Proctitis. 

This is a group of acute inflammations of the mucous membrane 
of the large intestine from the ileo-cecal valve to the anus. The in- 
flammation is mostly catarrhal, sometimes ulcerative, and is charac- 
terized by fever, pain, tenesmus and bloody stools. It originates most 
frequently in this country from errors in diet, exposure to cold, wet 
and general unhygienic conditions. Since the return of our soldiers 
from the Hispano-American war we have had added the amebic or trop- 
ical form, due to the presence of the ameba coli, in the ulcerations of 
the colon, stools, etc. ; of these the author has had a few to deal with. 
Another form is caused by the bacillus of Shiga, possessing flagella 
and motility. This bacillary dysentery is now found both in the tem- 
perate and tropical climates of our country. Infection occurs usually 
by means of the generous drinking of water, or food that has come 
in contact with or been contaminated by discharges. In the treatment 
of these cases rest in bed is an essential, and overexertion on the pa- 



DISEASES OF STOMACH AND INTESTINES. 245 

tient's part is best avoided, the bed-pan being used and all discharges 
sterilized with chlorinate of lime or ferrous sulphate. Liquid, bland 
diet, such as peptonized or predigested milk, liquid peptonoids, broths, 
egg-albumen, etc., should be employed. The first measure in the treat- 
ment of this disease is irrigation of the entire colon by hot water at 
a temperature from 105° to 110° F., to remove any offending food, 
bacteria or irritative material, which will give the bowel a much-needed 
rest. After this the rectum may be irrigated with cold water (55° 
to 60° F.J, repeated every two hours. It has been suggested to mix 
this water with alum, creolin and other drugs, and they may be added, 
although the author has never observed this to be of marked value. 
In amebic dysentery a 1-2500 solution of quinine, as suggested by 
Lorsch, has proved of value. These irrigations will relieve the inflam- 
mation, lessen the distension, diminish the stools, decrease the pain and 
tenesmus and add materially to the patient's comfort. 

Flydrotherapy is of unquestioned value. The plan originally sug- 
gested by Winternitz, and ably advocated by Strassel, has given the 
author very great satisfaction, both in acute and chronic conditions. 
It is the dripping sheet, commencing with a temperature of 80° F. 
and reducing two or three degrees daily until 60° F. is reached, fol- 
lowed by the cold sitz bath (75° to 60° F.) for eight to fifteen, even 
twenty minutes. Kellogg suggests the addition of the hot foot-bath 
during the administration of the sitz, and there is no objection to this, 
as it will increase the efficacy of the cold sitz and make the pa- 
tient much more comfortable; its temperature should be from 105° 
to 115° F. An important element in the administration of the sitz 
bath is gentle rubbing to the abdomen during its continuance. The 
rationale of this is to assist in maintaining tonic dilatation of the 
surface blood-vessels correlated to the intestines, for its aim is to pro- 
duce an anemia of the intestine, to lessen secretion and diminish peri- 
stalsis. Where it is not possible to administer the above treatment, 
the hot dry half pack, given for thirty minutes, followed by the ab- 
dominal compress at 60° F. for half to one hour, frequently repeated, 
will oftentimes prove of service. The wet pack, 70° to 60° F. for one 
or two hours, followed by the half bath, will sometimes overcome the 
marked adynamia that exists in these cases. Where it is desired to 
stimulate the general vital and resistive powers, the cold sponge may 
be employed every three or four hours, as is indicated. The author 
has found tannalbin of some value in connection with these treatments. 

Chronic Enteritis; Chronic Entero-Colitis; Chronic Intestinal Ca- 
tarrh; Chronic Diarrhea; Chronic Dysentery; Chronic Colitis; 
Chronic Proctitis. 

The above group of chronic inflammatory diseases of the intes- 
tines, small and large, are, as a rule, the flotsam and jetsam of acute 



246 PRACTICAL HYDROTHERAPY 

attacks ; the inflammation, congestion and frequent stools remain, 
changed some in character, but in general bearing much resemblance 
to the acute. The pain and suffering are not as marked, although 
these cases become weak, emaciated, lose vitality and strength, are 
anemic, dyspeptic, and the subjects of auto-intoxication. Many are 
markedly neurasthenoid, even melancholic, have tried many men and 
many things until at last they lose hope, mere existence becoming 
their lot. I do not hesitate to state that in these cases most brilliant 
results have been obtained by hydrotherapy, and instead of dreading to 
deal with these formidable maladies their treatment becomes simple, 
the result excellent where persistent treatment commensurate with the 
duration of the disease is persisted in. The diet must always be reg- 
ulated, be bland and unirritating — predigested milk, peptonoids, soups, 
broths, vegetable purees, dextrinized cereals, koumyss, plasmon, tropon, 
tender meats, fowls, fresh fish, eggs, spinach, well-cooked rice, etc. 
The hygiene and life must be regulated, and our aim should be to 
increase vital power and resistance by all means at hand ; regulate 
the diet so as to render the intestine a poor culture-medium, by local 
therapeutics to remove those products that will produce further irri- 
tation and inflammation ; to inhibit their action by germ-destroying 
applications, and through hydrotherapy improve the internal circula- 
tion, lessen secretion and diminish peristalsis until a normal condition 
is reached. The most satisfactory method of treatment, and one that 
has proved in my hands of almost unerring value, is the method of 
Winternitz. 

The patient, standing in a hot foot-bath at 110° F., is given the 
dripping sheet, commencing at a temperature of 70° F. for three min- 
utes, this temperature to be reduced three degrees daily until 60° F. 
is reached. This is followed by the cold sitz bath at 80° F., reduced 
three degrees daily to 60° F., or even 50° F. Its duration should 
be ten to fifteen minutes. After the rub, the patient, without being 
dried, immediately occupies the cold sitz bath, is thoroughly covered 
and rubs the abdomen vigorously. The action of the cold water upon 
the sensory nerves of the skin, accompanied by friction, causes a tonic 
circulation of blood in the cutaneous surface, as a result of which 
bowel secretion is reduced, circulation modified and peristalsis checked. 
With a cessation or improvement of the intestinal symptoms we may 
move to general treatment calculated to restore the devitalized and 
depreciated state of the patient. In the treatment of these cases the 
Turkish bath, hot air and electric light bath have been much employed, 
in conjunction with an ice-bag applied to the stomach and bowel. 
The author has, however, found the use of the incandescent electric 
light bath until perspiration, the horizontal rain bath at 100° F. for 
one minute reduced to 65° for ten seconds, followed by the cold sitz 
bath at 60° F. for ten minutes, accompanied by vigorous friction, a 



DISEASES OF STOMACH AND INTESTINES. 247 

most valuable method of treatment. To enhance its effect he sometimes 
uses the hot foot-bath at 110° F. In conjunction with this treatment 
we may employ enemata of nitrate of silver, ten to thirty grains to 
the pint of distilled water; normal saline; boric acid, five grains to 
the ounce; tannic acid, one or two drachms to the pint. The author's 
experience has been that the best results are obtained by the use of the 
normal saline, followed by medicated applications, of which the best 
is the aqueous extract of krameria in 2 to 10 per cent, strengths, as 
originally suggested by Tuttle. Associated treatment materially helps, 
especially massage, avoiding the abdomen and lower spine. The static 
wave current to the abdomen is a measure of no small value. 

Constipation. 

Constitpation may be defined as a functional inactivity, a slug- 
gishness of, or an imperfect emptying of the bowel. This may be 
either due to atony of the muscular coat or deficiency of secretions. 
It is a symptomatic condition, having its origin in many causes, and, 
in its turn, provoking disease or aggravating existing conditions. It 
is the bane of civilization. It causes especial irritation to nervous 
people, and produces many unpleasant symptoms associated with the 
cerebral and spinal functions, especially fullness of the head, mental 
depression, headache and neurasthenic symptoms. It deranges the 
digestion, causes dyspeptic symptoms, and in many instances is mis- 
taken for "indigestion," so-called. Through its influence the system is 
loaded with toxins, producing sallow skin, anemia and a host of other 
conditions. It throws a great deal of the labor of elimination upon 
the kidney, and has, in the writer's observation, caused a form of 
pseudo-Bnght's disease, in which a trace of albumin, cylindroids, 
many crystals of uric acid, oxalate of lime and indican are present. 
Its origin is to be most frequently found in those of sedentary habits, 
who lead an indoor life and who take little exercise ; who wear im- 
proper clothing ; who indulge in improper food and who overeat ; 
in those who are irregular and careless in the act of defecation and 
who are habitual users of laxatives. The essential element in the 
treatment is to remove the atony of the intestine, which is found 
especially in neurotics and neurasthenics; to increase the secretion, 
thus overcoming the dry fecal mass ; to strengthen the relaxed and 
weakened abdominal muscles. The first thing to be done is to stop 
the use of drugs and warm enemata, for we will find that it is to 
hygiene, diet, baths and electricity that we must look for a cure. 
Enemas and medicines aggravate the disease by causing paresis of the 
intestinal wall, and are apt to be followed by dilatation of the colon. 
Most of these cases drink little water, and for that reason they should 
be made to ingest large quantities, unless they are at the same time 
the subject of splanchnoptosis. The use of cold carbonated waters 



248 PRACTICAL HYDROTHERAPY. 

— Vichy, seltzer, etc. — before breakfast is more advantageous than 
plain. A regular hour for stools should be selected and adhered to 
strictly. Exercise in the open air, such as horseback riding, rowing 
and golf, are to be recommended, as are regular hours in eating. 
The diet, if possible, should be such as will leave some refuse or 
residue. Penzoldt suggests the following diet: 7 a.m., one glass of 
cold water; 8 a.m., generous breakfast of sweetened coffee, much 
butter, honey, graham or brown bread; 1 p.m., dinner of meat, much 
vegetables, salad, stewed fruit, farinaceous foods, cider or fruit juices ; 
7 p.m., meat with much butter, graham bread, stewed fruit; 10 p.m., 
before going to bed. fresh or stewed fruit. Fruits are of especial ad- 
vantage, such as figs, oranges, pears, stewed prunes, baked apples, 
as are nuts, brown bread and molasses. No alcohol, beer or wine 
should be used. The application of hydrotherapy acts as a tonic to 
the nervous system, increases the contraction of the abdominal walls, 
stimulates the secretion and favors elimination. A number of meth- 
ods have been suggested. Winternitz prefers the use of the dripping 
sheet at 60° F. for three minutes, with vigorous friction, followed 
by the cold sitz bath (50° to 70° F.) for two to five minutes. There 
is no question but what a cold sitz of short duration stimulates the 
muscular contraction of the intestine and increases secretion. The 
writer, however, has found that douches applied to the abdominal 
wall are more satisfactory, especially the cold fan and jet douche 
of brief duration to the abdominal wall and spine. Commence with 
the electric light bath or hot-air bath until profuse perspiration takes 
place. Follow with the horizontal or circular rain bath at 105° F. 
for one minute, pressure twenty pounds ; then the fan douche to the 
body for one-fourth minute and the jet douche to the spine for one- 
fourth minute, commencing at a temperature of 70° F., twenty pounds 
pressure, reducing the temperature two degrees daily to 60° F., and 
increasing the pressure two pounds daily until thirty pounds is reached. 
As soon as the patient has reached this point, give the following vig- 
orous treatment : Electric light bath or hot air to profuse perspiration ; 
circular rain bath, 105° F., pressure twenty pounds, for one minute; 
Scottish jet douche to the colon and abdominal wall, alternating be- 
tween 108° and 70° F., five and fifteen seconds each, under a pressure 
of ten to fifteen pounds for one minute. Increase the hot water a 
degree daiiy until 115° F. is reached; decrease the cold water one 
degree daily to 60° F., increase the pressure one to two pounds 
daily until twenty-five to thirty pounds is registered. Finish the 
treatment with the fan douche all over the body at 60° F. for ten 
to fifteen seconds. Care should be taken in administering the douches 
to always extend them so as to cover the region of the liver. It will 
be noticed that the application of a jet of very cold or very hot water 
to the abdomen causes instant and vigorous contraction of the ab- 



DISEASES OF STOMACH AND INTESTINES. 249 

dominal muscles and excites intestinal peristalsis. In spastic condi- 
tions of the intestine dependent largely upon nervous manifestations, 
it will be found best to avoid for a time the application of the cold 
douche to the abdominal wall, and simply use the hot. In certain 
cases of anemia, especially in women, it will be found advantageous 
to utilize the following measure : Sitz bath at 80° F. for two to three 
minutes, followed by the fan douche to the abdomen, 70° F., twenty 
pounds pressure, for one-half minute. Reduce the temperature of 
the sitz bath and douche two degrees daily until 60° F. is reached. 
The perineal douche applied to the perineum and anal region will often 
stimulate immediate peristaltic action when used at 60° F. for one 
to three minutes. 

As previously stated, the use of enemas is to be avoided, but if 
they have to be used it is preferable to use the normal saline solutions, 
warmed, finishing with a temperature of 70° to 65° F. 

In old cases of constipation accompanied by gastric derangements 
it has been often noted that lavage will produce activity of the intes- 
tine, and in this way overcome the associated bowel condition, as 
well as cleansing the stomach. Some foreign writers use lavage as 
a hydrotherapeutic measure in the treatment of constipation. All 
rectal diseases must be corrected, such as hemorrhoids, fissure, etc. 

As associated measures of great value, the local application of the 
static wave current, especially in those cases where gastro-intestinal 
catarrh is present ; the galvanic current, applied over the abdomen 
and lower spine, or, what is better, the slowly-interrupted sinusoidal 
current to the musculature of intestine and abdominal wall. In the 
writer's opinion, the least harmful laxative is cascara sagrada. 

Neuroses of the Stomach and Intestines. 

Under the above title we will consider a large number of affec- 
tions having as their origin disorders of the motor, sensory and se- 
cretory functions of the stomach and intestines, which are consid- 
ered together for brevity's sake and because they have, as a rule, 
to be treated by the same general methods. The treatment of the vari- 
ous disorders enumerated is similar, but it must not be supposed that 
it consists of fixed, cut-and-dried plans that should not be modified. 
When we deal with the nervous, neurotic, neurasthenic, hysteric and 
others of this type we have to consider each case as an entity, and 
this applies with full force to those nervous affections in which the 
hollow viscera of the stomach and bowel are involved. Many of 
them are minor ailments that cause the sufferer much discomfort, 
but should none the less receive our careful consideration. These 
have no known anatomic basis. Some have been considered under 
"States of Hypersecretion" and "States of Hyposecretion." 

Gastrahjia, or true neuralgia of the stomach, has been in my ex- 



250 PRACTICAL HYDROTHERAPY. 

perience a rather rare affection. An analysis should always be made 
to ascertain as to whether hyperchlorhydria exists ; diagnose by ex- 
clusion. 

Gastric hyperesthesia is, as Rugel says, "a morbidly increased sen- 
sibility of the sensory nerves of the stomach." This occurs nearly 
always after eating, thus differentiating the pain from that of gas- 
tralgia. I have seen several cases, and all were in markedly neuras- 
thenic persons. The chemic and other findings are never in propor- 
tion to the tenderness. In the same line are the peculiar sensations of 
"sinking at the stomach," heat and cold, etc. 

The derangements of appetite, anorexia, a loss of the desire for 
food ; hypcrkoria, an early sensation of satisfaction or satiety ; bou- 
limia, an exaggerated or insatiable desire for food ; akoria, a lack of 
the normal feeling of satiety; polyphagia, the eating of too much; 
parorexia, or altered appetite, will often be found to be accompanied 
by depressed nervous and psychic states, the treatment of which will 
be the guide. Some of these conditions may continue until life itself 
is at stake. These cases need institutional treatment and care. 

The motor neuroses of the stomach are affections brought about by 
varying actions of the muscular apparatus of the organ. Gastro- 
spa-sm, a spasm or cramp of the entire stomach; cardiospasm, a cramp 
of the muscles of the cardiac orifice ; pylorospasm, a cramp of the 
pylorus ; hyper peristalsis, or peristaltic unrest, an increase of the 
rhythmic contractions of the stomach of which the patient is aware. 

Reflex and nervous vomiting arise from some cause or irritant 
in other organs or distant parts of the body, particularly the genital 
organs, the eye, pharynx, and in rare cases diseases of the nose. The 
vomiting is usually painless, produces little depression, and the pa- 
tients enjey fairly good health. Psychic disturbances easily provoke. 
In this class we may mention the "periodic or cyclic vomiting of chil- 
dren" and the periodic vomiting of adults. 

Rumination, merycism, or "chewing the cud," is the raising of the 
food without nausea, remasticating and then swallowing. This oc- 
curs normally in the cow. Regurgitation is a similar habit, except that 
the food is rejected. It has been known to occur from imitation. 

Entcralgia is a rare neuralgia of the intestines. Closely simulating 
it, and very difficult of differentiation, is intestinal colic, a cramp or 
pain of intense character located in the intestines, usually brought 
about by some irritant in the bowel. Gaseous distension is usually 
present. Mctcorism, tympanites, are gaseous distensions of the bowel, 
the former localized, the latter diffuse. Peristaltic unrest consists of 
increased peristaltic movements, and is more common than the gastric. 

A careful study of each case must be made, including a quantita- 
tive analysis of the gastric contents, after which hygienic laws appli- 
cable to the case must be outlined. The treatment should be based 



DISEASES OF STOMACH AND INTESTINES. 251 

upon attention to the local condition, while at the same time general 
tonic and roborant methods are utilized with a view of reconstructing 
the nervous and general health, improving assimilation, stimulating 
metabolism and increasing the hemic functions. To this end a well- 
ordered life, with plenty of sleep, freedom from care and worries to 
the extent of a partial or complete rest-cure may have to be instituted, 
but it should be borne in mind that each case is a law unto itself and 
must be so met. The local treatment, where conditions of pain, unrest 
and discomfort exist, should consist of the application of the hot 
fomentation for fifteen or twenty minutes, followed by the abdominal 
compress for an hour. This may be repeated as frequently as every 
thirty to sixty minutes, and the writer has seen attacks of gastralgia 
promptly relieved by its application. Sometimes the drinking of very 
hot water or the use of a very hot high saline enema will promptly 
check the condition. Variations in secretions, loss and change of 
appetite, can be satisfactorily influenced by the application of the ice- 
bag over the stomach for an hour before meals. Lavage with alternate 
hot and cold water will exercise the same toning influence as that of 
the Scottish douche to the external surface. We must, however, 
look to general treatment for a radical relief of these conditions. 
Where one has no access to institutional treatment we may employ the 
full dry pack for thirty to sixty minutes, followed by the dripping 
sheet at a temperature of 70° F. for three minutes, reducing the tem- 
perature two degrees daily until 60° F. is reached. In institutions 
the hot-air bath or the incandescent electric light bath is preferred to 
the pack, and once having established the patient's reactive capacity 
we may give him the electric light bath to the point of free perspira- 
tion, followed by the horizontal or circular rain bath at 105° for one 
or two minutes. Follow this with the fan douche to the entire body 
for one-fourth minute and the jet douche to the spine for one-fourth 
minute at 70° F., under a pressure of twenty pounds ; reduce the tem- 
perature two degrees daily to 60° F. and increase the pressure two 
pounds daily until thirty pounds is registered. We may now proceed 
to a strong and stimulating measure needed by these cases. The elec- 
tric light bath is given until free perspiration takes place ; then the 
horizontal or circular rain bath at 100° to 105° F. for one and one- 
half minutes; the fan douche to the entire body one- fourth minute; 
the jet douche to the abdominal wall ten seconds ; jet douche to the 
spine for one-fourth minute. Commence these douches at a tem- 
perature of 70° F., fifteen pounds pressure; reduce temperature one 
degree daily to 60° F., or even 50° F. where the patient reacts well ; 
increase the pressure two pounds daily until twenty-five to thirty 
pounds is registered. 

These cases are helped by a sojourn at the seashore and surf 
bathing. This is especially beneficial as a "finishing" treatment, tend- 



252 PRACTICAL HYDROTHERAPY. 

ing as it does to give the patient a further rest from the cares and 
anxieties of life under most favorable and hygienic conditions. 

Certain associated treatments are of unquestioned value, espe- 
cially the use of galvanism applied over the abdomen and up and 
down the spine ; the static wave current will oftentimes materially aid 
in relieving the local condition ; so will mechanical massage, and vibra- 
tion and manual massage applied to the abdomen and general system. 



CHAPTER XIII. 

DISEASES OF THE NASO-PHARYNX, LARYNX AND CHEST. 

Acute Rhinitis; Acute Pharyngitis; Acute Tonsillitis; Acute Laryn- 
gitis; and the Treatment of Post-Operative Inflammations. 

Acute colds and acute sore throats are embraced under the above 
general heading. They are acute catarrhal inflammations of the mu- 
cous membrane of the nose, tonsils, uvula, soft palate, pharynx and 
larynx, being generally characterized by fever, painful deglutition, free 
discharge, coughing and a desire to clear the throat. The discharges 
are, as a rule, fluid, watery or mucous, very free in quantity. They 
have their most frequent origin in atmospheric changes, especially 
those due to exposure of the head and neck to draughts of cold air. 
A favorite method of acquisition is riding in street-cars while per- 
spiring, or the practice of wearing thin soles and stockings and sub- 
jecting the feet to cold and dampness. This is especially frequent 
with women. They sometimes arise from irritant vapors, dust, etc. 
In the treatment of these acute conditions, where the condition is not 
severe, it will be sufficient to simply diminish the quantity of food 
eaten, give rest to the throat and nose, spray them with antiseptics, 
open the bowels freely, and drink largely of carbonated water, an 
excellent example of which is equal parts of plain and Vichy water. 
If the case is severe it may become necessary for the patient to 
be put to bed. In any event general and local measures should be 
adopted. Where one has no accesss to institutional treatment an ex- 
cellent measure is the use of the hot full bath, commencing at a tem- 
perature of 100° F. and rapidly increasing to 108° or 110° F., if pos- 
sible. This should be followed by a very brief cold application — 
that is to say, a shower or cold sponge at a temperature of 70° to 60° 
F. This treatment is best given just before retiring, and after its ad- 
ministration the patient should be at once removed to bed, carefully 
covered and given a very hot foot-bath at 110° to 115° F. for ten 
minutes. There is no known home method with which I am familiar 
that will so surely abort these acute inflammations as the method 
above suggested. Where this is not accessible we may employ the full 
dry pack for thirty minutes, or the full wet pack for one hour, fol- 
lowed by the cold sponge at 60° F. and the hot foot-bath at 110° to 
115° F. for ten minutes. An excellent measure to relieve and abort 
the early stage of these inflammations is the Turkish bath, accom- 
(253) 



254 PRACTICAL HYDROTHERAPY. 

panied by free water-drinking. In sanatoria we employ the hot-air 
bath, electric light bath or superheated dry hot air to free perspira- 
tion, continued for several minutes, followed by the circular or hori- 
zontal rain bath at 104° for one minute under pressure of thirty 
pounds, reduced to 65° F. for one-third minute. With vigorous 
persons this may be followed by the use of the jet douche to the 
spine for ten seconds at 60° F. 

Local measures serve to relieve a great deal of the discomfort 
and hasten recovery. We may employ hot alkaline gargles, such as 
the normal salt solution, Seller's solution or antiseptic steam inhala- 
tions. Another excellent method is the fomentation to the face and 
neck every three hours, followed by the cold throat compress between 
times, or, what is better, the author's throat compress. Where the 
inflammation is very severe a partially filled ice-bag may be applied 
over the throat compress. 

Chronic Rhinitis; Chronic Pharyngitis; "Clergyman's Sore 
Throat"; Chronic Tonsillitis; Chronic Laryngitis. 

These are chronic inflammations of the mucous membrane lining 
the nose, pharynx, tonsil and larynx, which are characterized by a 
sensation of fullness, discomfort, increased secretion and perversion 
of the senses of smell and hearing and a change in the character of 
the voice. It most frequently results from repeated attacks of acute 
inflammation or from general depraved states. Certain preliminary 
measures are necessary for the successful treatment of these condi- 
tions. Where there are any hypertrophies, vegetations, enlarged 
tonsils, etc., these should be removed or corrected and at the same 
time local applications of nitrate of silver, picratol, argyrol or other 
medicinal measures utilized. Care must be taken to prevent acute 
attacks, and should they occur must be immediately treated. It has 
been the writer's experience that one of the most potent causes in 
these most troublesome affections has been the common and prevalent 
habit of mouth-breathing, which can at the present day be most 
certainly and surely overcome by means of simple mechanical devices 
which compel breathing through the normal channels. Especial care 
should be taken to secure proper digestion and elimination. Where 
we can build up the general health, secure plenty of open-air exercise 
or the use of gymnastics, we can frequently train the body to stand 
the exposures that would under ordinary circumstances produce severe 
acute attacks or gravely aggravate chronic conditions. To secure this 
desideratum it is essential that the activity of the skin be maintained 
at the highest, and that at the same time the cutaneous circulation 
must possess a tone that is not easily influenced by changes in tem- 
perature. Chronic inflammations of the upper respiratory passages 
are best met by measures general and local. At home we may pre- 



NASO-PHARYNX, LARYNX AND CHEST. 255 

scribe the use of the hot full bath at 102° to 105° F. for ten minutes, 
followed by the shower bath at 80° F. for one-half minute, reducing 
same two degrees daily until 60° F. is reached, followed by the hot 
foot-bath at 110° to 115° F. for ten minutes. To enhance and retain 
the circulation actively in the feet, the foot-bath should be followed 
by a douche of cold water over the feet. This treatment is best taken 
at bedtime every other night, the intervening nights being devoted 
to the use of the oil rub. Where such a treatment is inaccessible we 
may employ the full wet pack at 65° F. for one hour, followed by the 
cold half bath at 70° F. for three minutes, using vigorous friction. 
Reduce temperature of pack and half bath one degree daily until 
60° F. is reached. In institutions the most satisfactory method is 
the following: The hot-air bath, superheated dry hot air, and, what 
is probably the best, the electric light bath until profuse perspiration. 
Follow this treatment by the horizontal or circular rain bath at a 
temperature of 100° to 102° F. for one minute, reduced to 70° F. for 
one-fourth minute, twenty pounds pressure. Reduce temperature one 
degree and increase pressure one pound daily until a temperature of 
60° F. and a pressure of thirty pounds are registered. As soon as the 
patient responds well we may add to the electric light bath the follow- 
ing treatment: Horizontal rain bath to body for one- fourth minute; 
the jet douche to the spine one-fourth minute, especial care being 
taken to apply thoroughly to the cervical region. Each one of these 
methods should be followed by the cold foot-bath at 60° to 50° F. for 
one-fourth to one-half minute. Patients suffering from these chronic 
inflammatory troubles secure great benefit and help, oftentimes a 
permanent cure, from a sojourn at the seashore for several months, 
where they can utilize all the advantages that arise from freedom 
from business and affairs, pleasant recreation and surf bathing. Not 
only do we have the advantage in these cases of the percussory in- 
fluence of the cold and agitated sea water upon the skin surface, but 
the cleansing and healing influence of the strong saline that inad- 
vertently enters the nose, mouth and throat. 

Local measures are most valuable. The hot compress as hot as 
can be borne applied to the face, over the nose, around the throat 
and to the cervical spine, followed by the cold compress at 60° F. 
applied to the same regions. In addition to this treatment, the stim- 
ulating throat compress should be worn during the night. Much 
relief will be derived from a thorough cleansing of the nose and 
throat with alkaline sprays, followed by those containing menthol, 
camphor and the essential oils dissolved in alboline. 

Croupous Laryngitis. 

True or membranous croup is an acute inflammation of the mucous 
membrane of the larynx attended with the exudation of a tough 



256 PRACTICAL HYDROTHERAPY 

secretion or false membrane, the occurrence of spasm of the glottis, 
and characterized by febrile reaction, frequent peculiar cough, 
dyspnea and a tendency toward death by asphyxia. The affection is 
very fatal, and the danger is great in proportion to the age and 
feebleness of the patient. Hydrotherapy may contribute slightly 
tozvard relieving the symptoms. The hot full bath at 102° to 105° F., 
with a cold compress to the head, followed by a cold compress at 
60° F. applied over the larynx and changed every half hour, will 
frequently prove of service. No practitioner should fail to admin- 
ister, when in doubt, the diphtheritic antitoxin, and to have readily 
accessible every means for prompt intubation. 

Spasmodic Laryngitis; Laryngismus Stridulus. 

False or catarrhal croup is a catarrhal inflammation of the mucous 
membrane of the larynx, associated with temporary spasmodic closure 
of the glottis, characterized by paroxysmal coughing, difficulty of 
breathing and attacks of threatened suffocation. Laryngismus strid- 
ulus is a spasm of the muscles of the larynx, characterized by sudden 
dyspnea and deficient oxygenation of the blood. These require one 
and the same treatment, and will be therefore considered together. 
The attacks occur most frequently in children. The preventive treat- 
ment of these conditions should have for its object the removal of all 
enlarged tonsils, adenoids and nasal obstructions of every kind. 
During the paroxysm the child should be at once placed in a hot full 
bath and at the same time a cold compress at 60° to 50° F. applied 
over the larynx. This may be used in conjunction with spraying of 
the throat with a 2 per cent, aqueous solution of cocaine. As soon 
as the paroxysm is relieved the patient may be removed to bed and a 
cold throat compress at 50° to 40° F applied to the neck. This 
should be removed at the end of every three hours, at which time a 
hot fomentation may be then applied for one-half to one minute over 
the larynx and two to three minutes over the cervical spine, followed 
again by the cold throat compress. Kellogg suggests that during the 
spasm or paroxysm the chest be percussed with the wet end of 
a cold towel o cold water be dashed over the chest. During the inter- 
paroxysmal period steam inhalations, to which some creosote has been 
added, will often prove comforting and satisfactory. As soon as 
improvement takes place we must reconstruct the general health and 
prevent attacks by hardening the skin by the use of daily cold tonic 
measures. Even infants can be gradually and systematically trained 
to stand cold water, but it takes patience, firmness and insistence on 
the part of the attending physician to overcome the unfounded fear 
of the laity of cold water. 



NASO-PHARYNX, LARYNX AND CHEST. 257 

Acute Bronchitis; Capillary Bronchitis. 

Acute bronchial catarrh is an acute catarrhal inflammation of the 
bronchial tubes, characterized by fever, pain and constriction of the 
chest, oppression in breathing and a more or less profuse expectora- 
tion. It is found frequently in children and in the aged and in those 
who are exposed to an atmosphere that is cold and damp. It occurs 
especially after measles and influenza, its exciting cause being micro- 
organisms ; many staphylococci and streptococci are found in the 
sputum. As a rule its mortality is small, only very aged and feeble 
persons succumbing. The patient should be, as a rule, confined to a 
well-ventilated warm room, and if feeble placed in bed; restricted 
soft or liquid diet may be prescribed and calomel administered. The 
first aim should be the securing of free skin action, as this will 
relieve the visceral congestion and eliminate toxins. In practice we 
may employ the following procedure : Allow the patient to sip a glass 
of very hot water, after which we may use either the full dry pack 
for thirty minutes, the wet sheet pack at 70° F. for one hour, or a hot 
full bath at 104° to 105° F. for ten minutes, in each instance re- 
moving the patient to bed and following with the cold sponge at 60° 
F., or the dripping sheet at 70° for three minutes. This treatment 
may be repeated once or twice daily if necessary, though the latter 
is not suggested. Where we have to deal with an irritable, tenacious 
and weakening cough it will be found advantageous to allow the 
patient to sip and gargle the throat with very hot water or inhale 
steam. Much benefit will be derived from the use of the chest com- 
press in addition to the above measures. There is no question but 
what many cases of acute bronchitis could be greatly modified, cut 
short or even aborted by having recourse at its immediate commence- 
ment to the Turkish bath. In institutional treatment we find the 
electric light bath to the point of profuse perspiration, followed by 
the dripping sheet at 70° to 60° F. for three minutes, or the horizon- 
tal or circular rain bath, 70° to 60° F., for one-fourth minute, most 
useful. The author has, however, allowed superheated dry hot air 
to supersede the other methods. The patient is placed in the body 
apparatus for twenty to forty minutes at temperatures ranging from 
250° to 300° F., especial care being taken to place a cold compress 
or ice-bag upon the head. The patient is removed from the apparatus 
and allowed to perspire in a blanket pack for ten or fifteen minutes, 
after which the horizontal or circular rain bath at 70° F. for twenty 
seconds is then administered. In my hands nothing has equalled these 
measures in the prevention and cure of bronchial affections. 

What has been said of acute bronchitis is equally applicable to 
capillary bronchitis, an acute catarrhal inflammation of the mucous 
membrane of the bronchioles, and characterized by fever, impeded 



258 PRACTICAL HYDROTHERAPY. 

respiration, slight cough and scanty expectoration. Huebner 1 has 
suggested the following plan of treatment in the suffocative stage of 
this disease in children: Half a kilo of fresh mustard flour is thor- 
oughly stirred into one and one-half litres of warm water until the 
fumes arising from the mixture become irritating to the eyes. This 
requires about ten minutes. A sheet sufficiently large to envelop the 
child is then saturated in this mixture, wrung out and spread on a 
blanket. On this the child is placed naked, then closely covered by 
the sheet from the feet to the neck, the blanket being brought over 
all, so that a moist mustard full pack is the result. In this the child 
should remain from ten to fifteen minutes, until it shows by its rest- 
lessness that the irritation of the skin is becoming pronounced. It 
is then quickly removed from the pack, washed in plain warm water 
to remove all trace of mustard, and then placed in a warm pack made 
by wringing a sheet out of plain water, and covered by a blanket. 
In this pack the child should be left for one or two hours, the length 
of time being controlled by the temperature of the child, which is 
likely to increase. When this occurs, or when a very profuse perspi- 
ration appears, the child should be removed, again bathed in plain 
warm water, then dried, clothed in an ordinary gown and returned 
to bed, where it should be left undisturbed. The procedure should 
not be repeated within twenty-four hours, but in severe or prolonged 
cases may be employed daily for three or four days. Though more 
tedious, it is applicable under a greater variety of circumstances than 
the hot mustard bath, and, as it is better borne, allows time for a 
more pronounced effect. 

Chronic Bronchitis; Fibrinous Bronchitis. 

Chronic bronchial catarrh is a chronic inflammation of the mu- 
cous membrane of the larger and middle-sized bronchial tubes, char- 
acterized by cough and more or less profuse expectoration, usually 
following a succession of acute attacks. It is common in the aged, 
accompanies the infections, and may arise indirectly from gout, alco- 
hol rheumatism or syphilis. It is frequently associated with chronic 
gastric catarrh. The treatment of this condition should bear in mind 
the causal relations above mentioned, the treatment of which will be 
found under their respective headings. In all cases an equable tem- 
perature of the chest should be secured, the best garments to be worn 
being woolen ones of medium weight. Care should be exercised not 
to dress too heavily, owing to the fact that upon entering warm rooms 
slight perspiration is apt to take place, which would be followed by 
chilling upon entering the external colder air. Draughts, especially 
damp, cold weather, wet feet and overexertion must be guarded 
against. The writer has had an extended experience in the treatment 

1 Therapie der Gegenwart, 1905, p. 1. 



NASO-PHARYNX, LARYNX AND CHEST. 259 

of chronic bronchitis, and believes that the basis of restoration of 
the bronchial tubes is the restoration of the normal general tone, 
while at the same time we lessen the local inflammation. The aim 
should then be to remove all causal factors, at the same time reducing 
the local inflammation and building up the general health. There is 
no question but what the administration of alkaline waters in consid- 
erable volume is of great benefit to those afflicted with this disease. 
Many suggest the use of water of alkaline mineral springs, but the 
writer has found the ordinary alkalies, well diluted, to be just as valu- 
able as the much-vaunted waters. The diet should be reconstructive, 
and contain a large quantity of fats, butter, milk, cream, olive oil, 
mayonnaise dressing and other foods of a similar nature. The oil 
rub at night, used in conjunction with hydrotherapy, is a valuable 
measure. Care should be taken to correct nasal, tonsillar and pharyn- 
geal troubles, as these are weak spots tending to accentuate and per- 
petuate the bronchial condition. These cases should be taught respira- 
tory gymnastics, especial benefit being derived from the outward and 
inward movements of the arms. It is my custom to suggest deep 
inhalations half a dozen times during the day. Much good can fre- 
quently be derived from the correction of mouth breathing, thus 
preventing the irritating effects of improperly heated and moistened 
air entering the bronchial tubes. As chronic bronchitis occurs more 
often in the aged, it is well to commence with very mild measures, 
carefully securing reaction in each instance. The writer generally 
commences with the use of the electric light bath until the patient 
is warm, after which there is administered a salt rub, followed by 
a rapid cold sponge, the temperature of the water being at 80° F. ; 
reduce the temperature two degrees daily to 70° F. We may now 
proceed to the use of the following method : Electric light bath, hot 
air or dry pack until perspiration just commences, then the dripping 
sheet at 70° F. for three minutes, accompanied by vigorous friction. 
Rub well afterward with a crash towel until reaction is secured. 

In some cases this is followed by a rapid oil rub. This treatment 
should be repeated daily, reducing one degree each treatment until 60° 
F. is reached, at which time we may move up another step, as follows: 
The electric light bath or hot air until commencing perspiration, fol- 
lowed by the horizontal or circular rain bath at 100° to 104° F for 
one to one and one-half minutes, twenty pounds pressure; reduce to 
70° F. for one-third minute. Reduce the temperature one degree 
daily until 60° F. is reached and increase the pressure one pound until 
thirty pounds is registered on the gauge. These cases are always 
best treated in sanatoria. It is astonishing to notice, where the treat- 
ment is carried out carefully, thoughtfully and painstakingly, how 
the skin of these individuals will lose its gray, greasy, leathery look, 
assume a softer and better character; how the color will come to the 



260 PRACTICAL HYDROTHERAPY 

surface ; how the irritating and hacking cough will lessen ; how ex- 
pectoration will become freer and finally cease ; how the appetite, 
digestion and elimination pick up. It is a metamorphosis not as 
rapid, but as pleasing, as those that arose from the magic influence 
of Aladdin's lamp. 

Pulmonary Congestion. 

Pulmonary engorgement, hypostatic congestion, is an increase or 
abnormal fullness of the capillaries surrounding the air cells ; active 
when the result of accelerated circulation and passive when caused 
by an impeded outflow from these vessels. Active congestion of the 
lung most often occurs from prolonged exposure to cold, over-exer- 
tion or the inhalation of cold or hot air. The writer has seen two 
cases due to prolonged swimming in cold water. The passive arises 
in those obstructed conditions in which we have to deal with valvular 
disease and dilated heart, nephritis, or in the infectious fevers. In 
treatment these conditions must be taken into consideration, and 
where they act as causal factors appropriate measures must be adopted. 

In acute congestion the endeavor should be made to withdraw the 
blood from the lung and cause a contraction of the capillary blood- 
vessels. This is best accomplished by rest in bed, with frequent 
changes of position. Administer a very hot foot-bath (110° to 115° 
F.)for fifteen to twenty minutes, with the legs immersed to the knee. 
This should be followed by the hot dry half pack or the hot wet half 
pack applied to the lower limbs and as high as the umbilicus. At 
the same time we may apply the cold chest compress, 50° to 60° F., 
and repeated as necessary, from twenty to thirty minutes, or the 
double-column Chapman hot-water bag to the upper dorsal spine. 
There is no objection to using the cold chest compress anteriorly and 
the Chapman hot-water bag to the dorsal spine posteriorly. 

In the passive or hypostatic form, which usually occurs in febrile 
conditions or systemic disease, much can be accomplished by frequent 
change in position. Where hydrotherapy is employed in fevers hypo- 
static congestion is a rarity. When conditions of obstructed circula- 
tion or nephritis occur, these diseases must be treated in order to 
overcome the condition. The best treatment of passive congestion of 
the lung is the application of the hot fomentation for ten minutes 
to the entire chest, followed by the cold chest compress at 60° F., 
renewed every three hours. Before every application of the compress 
the fomentation must be repeated. 

Pulmonary Edema. 

Pulmonary edema is an exudation of serum into the pulmonary 
tissue and alveoli, characterized by frothy, blood-streaked expectora- 
tion, cough and dyspnea. It is a grave condition, and is in the major- 



NASO-PHARYNX, LARYNX AND CHEST. 261 

ity of instances a symptom of some acute or chronic disease. For 
that reason remedial measures offer little. The conditions that pro- 
duce the trouble, whether they be cardiac disease, nephritis, or an 
infectious disease, are the ones to be treated. In this disease, as in 
pulmonary congestion, we may employ the hot foot-bath to the knee 
at 110° to 115° F. for fifteen to twenty minutes, followed by the hot 
dry half pack, together with the cold chest compress at 60° for twenty 
to thirty minutes, repeated as often as necessary. To sustain the 
heart the ice-bag should be applied to the precordium, and strychnia 
and atropine injected hypodermically. Little can be accomplished 
by this treatment unless other measures reaching the causal condi- 
tions are successful in removing them. 

Hemoptysis — Pulmonary Hemorrhage. 

Hemoptysis is the expectoration of blood — in fact, is a pulmonary 
hemorrhage — which may arise from the bronchial tubes or from the 
broncho-pulmonary tissues. It is usually a symptom of some other 
disease, generally tuberculosis, or may occur from other causes, and 
where these exist the treatment of the causal condition must be taken 
into consideration. Pulmonary hemoptysis demands, in the writer's 
opinion, an immediate hypodermic injection of morphine and atropia, 
without the addition of any other drug, ergot and its ilk being value- 
less. Examine the nose and throat for bleeding points, which, if they 
exist, touch with a styptic. Rest in bed is imperatively demanded in 
a room that is kept cool. The diet should be liquid and as little as is 
consistent. The swallowing of small pieces of ice sometimes helps, 
and all hot or warm drinks should be avoided. If the hemorrhage is 
actively taking place, a bandage should be applied to the legs to pre- 
vent, as much as possible, the return of blood toward the lungs, and 
partially arresting the return flow. A tumbler of ice water in which 
a tablespoonful of salt has been dissolved sometimes helps. Apply 
ice-bag to the supraclavicular fossa and the cold chest compress at 
40° to 50° F. for fifteen to twenty minutes, repeating as often as is 
necessary. The Chapman double-column hot-water bag should be 
applied to the upper dorsal spine, its action being to cause a contrac- 
tion of the blood-vessels entering the lung. When the hemorrhage 
has been checked, care must be exercised in the return to activity and 
in the adoption of further measures. It may be added, as a final word, 
that the after-treatment consists in the management of the disease 
causing the hemorrhage 

Lobar Pneumonia; Catarrhal Pneumonia. 

Pneumonia is an acute infectious inflammation, involving the vesic- 
ular structure of the lung, rendering the alveoli impervious to air, 
and characterized by fever, cough, thoracic pain, dyspnea, headache. 



262 PRACTICAL HYDROTHERAPY. 

rusty sputum and great prostration. Its origin is a specific organism, 
the diplococcus pneumoniae of Fraenkel, although mixed infections 
occur. The seat of election and its chief effects are upon the lung, the 
micro-organism being found in the sputum. It is a disease of grave 
prognosis, the mortality of which ranges from 20 to 40 per cent. 
Old age and alcoholism render the prognosis bad. In no acute infec- 
tious disease does temperate living and a moral life count for as much 
as in an attack of acute pneumonia. One attack predisposes to another, 
as does exposure and debilitated conditions. The seriousness of the 
disease demands that we shall, from the start, use every measure that 
will conserve the energy and strength of the patient and at the same 
time enhance vitality. The patient should at once be placed in a room 
from which all useless objects have been removed, the temperature of 
the room being maintained at 65° F., with an abundance of pure 
warm air. The bed should be single, protected from draughts, acces- 
sible from either side, the mattress being protected by rubber cloth 
or sheet. The patient should be clothed in a soft flannel gown opening 
its entire length in front. The bedclothes must be light, the sheets 
changed frequently, the expectoration and discharges caught in vessels 
in which are antiseptic solutions and later burned. The diet should 
be liquid, using milk, broth, egg albumen-orange solutions, etc. Baruch 
recommends the use of six ounces of cold water every two hours, 
alternating with the same quantity of cold milk, night and day, when 
the patient is awake, the result of which is an enormous increase of 
urine, scarcely credible, even as much as 60 to 122 ounces in twenty- 
four hours. Todd 2 says that "six to eight ounces of water, alkalinized 
by adding two and one-half grains of sodium chloride and ten grains 
of potassium bicarbonate to the ounce, should be given every two 
hours." If a teaspoonful of lemon juice is added it makes a pleasant 
effervescent drink. The author first learned of this in 1884 from an 
Italian physician, and has found it a palatable beverage. There is no 
question but what the free ingestion of cold alkaline water is of de- 
cided benefit to these cases, in that it favors oxidation, which is so 
much needed, and at the same time acts as a diluent and eliminant 
of toxins and waste products. 

Care should be exercised not to over-feed, as the loss of strength 
is due to poisoned nerve and muscle, and not to a lack of nutrition. 
It should further be borne in mind that with the loss of air, due to 
the involved lung structures, there is deficient oxidation in the boc : v, 
and food is not utilized. It is irrational and unphysiological to feed 
patients large quantities of food they cannot assimilate, and this is 
essentially true of the acute infectious diseases. Food is best admin- 
isterd at periods of every three hours, care being taken to avoid a 
distended stomach and abdomen. "If pneumonia be regarded as a 

2 Todd. T. V.- . New York Medical Journal. 1905. 



NASO-PHARYNX, LARYNX AND CHEST. 263 

constitutional malady with a local lesion, then the consolidated lung 
no more calls for treatment than does the intestinal ulcer of typhoid 
fever, but the general condition of the patient is to govern in the man- 
agement, and in the local changes in the thorax." In all treatment 
that is instituted especial care should be taken to prevent pulmonary 
congestion from exposure of the shoulders or chest to chill by evap- 
oration. There is no specific treatment for pneumonia, but the patient 
must be carefully and closely watched and treatment adjusted to con- 
ditions. At the outset there is no question but what calomel should be 
prescribed in good purgative doses. The aim and object of the treatment 
in pneumonia is the maintenance of vital activity until opportunity 
has been afforded the system for the elimination of the toxins and the 
development of antitoxins, which assist in the suppression of the dis- 
ease and bring about natural healing processes. 

In hospital and private practice this is the most fatal of all acute 
diseases. The most striking and important similarity between this 
and typhoid fever is that the chief point of attack is upon the nervous 
system ; the toxemia resulting from the life and death of the micro- 
organisms spends its chief force upon the nerve centers. The treat- 
ment, therefore, resolves itself into two lines — local measures, which 
may be adopted to lessen the production of toxic material in the lung 
and obviate the mechanical obstacle to respiration, and general meas- 
ures, which should be directed toward minimizing the toxic effects 
upon the system by maintaining the highest vital resistance. Owing 
to the sensitiveness of the pneumococcus, local measures are essen- 
tial and satisfactory. 

The best local method of combating the lung condition is the use of 
the chest compress, which would be applied at a temperature of 60° 
F. and repeated every hour when awake. The efficacy of the com- 
press is frequently enhanced by the application of a hot fomentation 
before every third or fourth application of the compress. Where the 
fever is very high the compress may be repeated as often as every 
twenty minutes, though, as before stated, care must be taken to avoid 
chilling by evaporation. The action of the compress is a good deal 
that of the action of cold in general in infectious diseases — stimulation 
and invigoration of the nerve centers by its impact upon the cutaneous 
surface and the reaction that follows. Reflex influences are conveyed 
to the lungs, and as a result congestion is lessened and expectoration 
increased. Upon the circulation its action is that of a cardiac tonic, 
first contracting the superficial blood-vessels, which is followed later 
by a tonic dilatation. Reflexly, heart action is benefited. Reduction 
of temperature is also favored by the application of the compress 
over the lung, this being the seat of the greatest amount of heat 
generation. In pneumonia cold is more valuable because of the 
greater danger to the patient of a persistent high temperature, which 



264 PRACTICAL HYDROTHERAPY. 

is enfeebling the heart, mechanically overworked already. There is 
no question but what the life cycle of the germ is shortened by cold 
applications, and therefore the quantity of toxins produced lessened. 
In the early stage of the disease we do not expect cardiac collapse, 
but should this be threatened apply the ice-bag over the heart for 
periods ranging from ten to fifteen minutes every hour, repeated as 
often as is necessary. 

Dr. T. J. Mays, of Philadelphia, advocates the use of ice-bags to 
the chest in pneumonia. He says : 

"Very often it is found that the application of ice to an affected 
spot is immediately followed by a marked lowering of the temperature 
and improvement in the physical signs in the part. When we come 
to compare the results of the ice-cold treatment of pneumonia with 
those that have been obtained from other forms of treatment, it is 
safe to say that the former is infinitely more satisfactory than the 
latter. Cold reduces the pyrexia, strengthens the pulse, tones up the 
heart, diminishes the pain in the chest, alleviates the difficulty of 
breathing and gives greater general comfort to the patient. It is 
capable, however, of doing a great deal more. By virtue of its 
power to stimulate nerve function and to contract small blood-vessels 
it promotes the pulmonary circulation, relieves stasis, hastens reso- 
lution and disperses the products of exudation." 

Lees 3 lays down the following rules for guidance in the use of 
the ice-bag: 

"1. Apply the ice-bag over the dull area, and especially over the 
advancing edge of the consolidation. 

"2. If the area is large, use two ice-bags, or even three. 

"3. Expect to find a distinct local effect ( less bronchial breathing 
and looser rales) on careful physical examination after the ice has 
been applied for twenty- four hours. 

"4. If fresh areas of consolidation develop use additional ice- 
bags ; four or even more may be used in a bad case. Correct dosage 
is as important as with drugs. 

"5. Apply hot-water bottles to the feet and legs. In children apply 
these before applying the ice. 

"6. Examine the signs twice daily and shift the ice-bags accord- 
ingly. 

"7 If pericarditis is present as a complication, place an ice-bag 
over the heart. 

"8. If the temperature is below 99° F., or if the hands are cold 
or the lips blue, remove the bags for an hour, then replace them and 
use them for two- or three-hour periods, with one- or two-hour 
intervals. 

"9. In severe cases with cyanosis and with a rapid, feeble pulse, 
consider whether leeches would not relieve the right heart. 

"10. Pneumonia treated with ice within twenty-four hours after 
the rigor may sometimes be aborted." 

In this connection Kellogg says that "several ice-bags may be used 



3 "Cohen's System of Physiological Therapeutics," Vol. IX. 



NASO-PHARYNX, LARYNX AND CHEST. 265 

in place of the cold ccmpress, but the bag should be removed at least 
every half-hour and the chest rubbed until red and warm to maintain 
surface circulation and skin reflexes." In this the author thoroughly 
agrees ; its omission is a mistake. In bad cases in children the full 
hot bath, 102° F. or hotter, may be employed for two to five minutes, 
followed in its turn by the chest compress at 70° to 65° F. for 
twenty to thirty minutes. The preliminary hot application dilates 
the peripheral blood-vessels and relieves the heart. 

That the chest compress meets every indication can be readily 
appreciated when we stop and reflect that by its direct action it lowers 
the bacterial life and activity, thus diminishing the development of 
toxins ; by tonically dilating the superficial blood-vessels of the chest 
congestion is relieved and dyspnea lessened ; the heart and vasomotors 
are stimulated, the pulse strengthened, its dicrotic character removed, 
its rate lowered and size increased ; the bettered and less obstructed 
circulation, together with the ingested alkaline beverages, raises blood 
pressure, increases the urine and thus removes the toxins present ; 
perspiration is induced, heat loss favored and maintained by the 
slowly evaporating moisture through the flannel covering of the 
compress ; the shock of the' impact of cold upon the peripheral nerve 
terminations rouses and stimulates the entire central and vegetative 
nervous systems, thus fulfilling every indication and need. 

In many cases the use of the local measures above indicated will 
be all that is necessary, although two or three times a day we may 
increase the vital strength of the patient by using the cold sponge 
applied to the extremities, although many writers do not deem this 
an essential feature. 

Loomis 4 says that in alcoholics he employs the full bath at 103° F. 
or more when patients are delirious, after which they are sponged 
regularly when the temperature is 102° F. Sweating is often im- 
perative in these cases, and he employs the following method : 
Sweating may be induced by the hot (110° to 120° F.) foot-bath 
given in bed without any disturbance to the patient. The patient, in 
a nude condition, lies between blankets with his knees flexed, his feet 
in the tub, which has been placed under the blanket, the long axis 
being in the line of the patient's body and legs ; another blanket passes 
from under the tub up over the end and over the knees of the patient. 
From two to five blankets, or a fewer number of blankets and a 
rubber sheet, are then placed over the patient, extending from head 
to foot and tucked around the patient. The tub is at first filled half- 
full of hot water, in which a heaping tablespoonful of mustard has been 
dissolved and hotter water added as indicated. The bath is kept up 
for from thirty to forty-five minutes, according to the amount of 
sweating produced. During the application of the bath cold cloths 

4 Loomis, H. P.: "Practical Medicine Series of Year-Books, " 1906. 



266 PRACTICAL HYDROTHERAPY. 

wrung out of ice-water or the ice-cap are kept constantly on the head 
of the patient. 

The cold full bath has been used in hospital practice by a number 
of physicians, but the writer is of the opinion that the full cold bath 
is hardly as satisfactory in this disease as in typhoid ; in fact, he agrees 
with Baruch, that we will find in the compress all that is necessary 
to overcome the disease, combat the symptoms and maintain vital 
resistance. Brown 5 states that he has found the full strength Nau- 
heim bath of signal benefit in these cases, lessening the respiration, 
lowering pulse-rate, strengthening the heart's action, preventing en- 
feeblement and dilatation. This bath's well-known action of raising 
the blood pressure not only takes place at the time, but is sustained 
for long periods afterwards. 

Certain prominent symptoms may oftentimes be mitigated by the 
use of hydriatic measures. Where cough is constant and irritable 
the use of steam inhalations for ten to fifteen minutes every hour 
should be employed until this troublesome symptom is relieved. I 
have seen much benefit derived from the taking of teaspoonful doses 
of very hot water, it having frequently, in my experience, stopped 
even the cough of tuberculous patients. In case of headache, insomnia, 
and delirium, the use of the cephalic compress, over which the cephalic 
coil cap is placed, will very promptly give relief, although these condi- 
tions are, as a rule, prevented by the use of the cold chest compress. 

Convalescence is tedious, and care should be exercised in getting 
the patient upon his feet, especial attention being paid to the condi- 
tion of the pulse and heart. 

Behrmann" says that after long experience with hypdrotherapy in 
pneumonia he has found it the best method. When the acute stage 
terminates and convalescence makes no progress, as shown by in- 
creased evening temperature, rhonchi, dull areas, irritability, increased 
thirst and decreased perspiration, vigorous measures are needed. 
If the temperature is 100.4° F. or higher, use chest pack re-wet 
every two, three or four hours in water at 68° to 75° F. ( 20° to 
25° C.) for one hour, rubbing the patient dry after each application. 
If there is marked differences between auscultation and percussion, 
and the temperature is normal or subnormal, with rhonchi and dulness, 
wet the pack or compresss in water at 86° to 91.4° F (30° to 33° C), 
or even 100.4° F. (38° C), using it the same length of time. 

Gradually increased diet, which should be highly nutritious, to- 
gether with tonics of iron, quinine, strychnine, hypophosphites, etc., 
is indicated. When the patient is able to be about general tonic 
measures should be at once administered, the best of which are the 
incandescent electric light bath, followed by the dripping sheet, rain 

5 Brown, Fhilip King: American Medicine. September. 1901.. 

6 Blatter £. klin. Hydrotherapie. 1904. 



NASO-PHARYNX, LARYNX AND CHEST. 267 

bath, jet douches, or some other well-known method. Where con- 
solidation continues the local application to the spot of the fomenta- 
tion will assist materially in resolution. I have also found the 
galvanic current of considerable value in overcoming this condition. 
Many writers recommend blisters and tincture of iodine. 

Catarrhal pneumonia may be treated in the same general manner 
as lobar pneumonia. 

Asthma; Hay Fever; Hay Asthma. 

Bronchial asthma is a paroxysmal, spasmodic contraction of the 
muscular layer of the smaller bronchial tubes, characterized by more 
or less frequent spasmodic attacks of distressing dyspnea and usually 
accompanied by chronic bronchitis. This neurosis of the respiratory 
apparatus may result from either local or general conditions, espe- 
cially those that have an influence upon the nervous system. These 
cases are especially sensitive to atmospheric changes, and easily catch 
cold, the result of which is likely to be an attack or paroxysm of the 
affection. Many cases have peculiar idiosyncrasies that will cause a 
paroxysm. The disease is essentially a chronic one, and as a rule 
perfect recovery seldom occurs save in those cases that are due to 
general conditions or to reflex causes. The better the general health, 
the better the condition of the nervous system, the less tendency 
there is to attacks. Drug medication has proved itself of compara- 
tively little value during the acute or chronic stage, and of the acute 
stage this may likewise be said of hydrotherapy. Our aim should 
be between attacks to build up the general health, increase the nerve 
tonus and so harden the integument as to reduce the susceptibility of 
the patient to a minimum. By these means we remove the most 
fertile causes of the attacks. These cases are very susceptible to cold 
water, and must be trained with great care to stand its application ; 
and as its value is unquestioned it becomes a necessary factor in the 
treatment of the case. 

During the paroxysm relax the patient by immersion in a hot full 
bath (104° F. or higher), or apply the fomentation to chest at 140° 
to 160° F., first posteriorly then anteriorly, until relief is obtained. 
In the interparoxysmal or chronic stage apply the fomentation at 
140° F. night and morning, wearing between times both day and 
night a stimulating compress, the temperature of which should be at 
the start 85° F. ; gradually reduce the temperature one degree daily 
until 65° F. is reached. Another excellent method is to employ the 
full hot bath, commencing with the neutral temperature of 95° F. 
and increase two degrees daily to 104° F. or higher for fifteen to 
twenty minutes, followed by the affusion to the abdomen of the water 
at 55° F. The best way is to allow the hot water to run out until 
there is only six inches in the tub, at which time the affusion is given, 



268 PRACTICAL HYDROTHERAPY 

while the' patient is sitting in the water. It causes deep inspiration 
and expiration, loosens and aids expectoration, relieves fullness and 
stimulates intestinal activity. In institutional cases we may commence 
with the electric light bath until perspiration takes place ; remove the 
patient from this and give an alcohol rub. He should now lie down 
and carefully avoid any chilling. 

The writer wishes to say in passing that it is his opinion that the 
electric light bath possesses unusual efficiency in the treatment of 
this disease. He has tried carefully to analyze in what manner this 
takes place, and has been unable to reach any exact or definite con- 
clusion, but the clinical fact remains that it is the most satisfactory 
treatment we have along hydrotherapeutic lines. After we have 
given two of these treatments commence with the cold sponge at 
80° F., rapidly performed, starting with the extremities and termi- 
nating with the chest. As soon as this is well borne the water may be 
gradually dropped one degree a day until 70° F. is reached. Con- 
tinue electric light bath and substitute for the cold sponge the fol- 
lowing: The dripping sheet at 70° F. for two minutes with vigorous 
friction, the patient during its application standing in a hot foot-bath 
just as hot as can be borne. As soon as satisfactory reaction is 
obtained the following treatment, which has given the author much 
satisfaction, may be instituted: The electric light bath until free 
perspiration takes place, followed by the circular rain bath at 104° 
to 105° F. for one minute, reduced to 70° F for one-fourth minute, 
followed by the fan douche to the back of the chest at 70° F. for 
one-fourth minute. The pressure should commence at about fifteen 
pounds and be cautiously and gradually raised to not exceed thirty 
pounds. Foreign writers recommend the cold chest compress or 
pack, well protected, and continued for quite a length of time. 

As associated measures of considerable value we may mention- 
treatment of any affection of the nose or throat that may exist. Me- 
chanical vibration systematically applied, as well as the static wave 
current, directly to the chest walls, will prove additional aids in treat- 
ment. I have seen some good results come from the long-continued 
administration of iodine and arsenic. Digestive, pelvic and rectal 
lesions, when corrected, sometimes result in unexpected benefit. 

The treatment above outlined is also applicable to hay fever, hay 
asthma and acute specific catarrhal inflammation of the upper air- 
passages occurring during the "hay fever season" — that is to say, 
during the time of the presence of certain pollens in the air, the result 
of their action being to produce cough and difficult respiration. 
Young subjects may at once be placed upon the full treatment sug- 
gested. Care should be taken to keep the air-passages clean with alka- 
line sprays ; limit the diet, from which meat has been wholly removed ; 
increase the drinking of water, correct digestive disturbances and 



NASO-PHARYNX, LARYNX AND CHEST. 269 

overcome constipation. These cases will usually be found to be neu- 
rotics who lead a sedentary life and who are the subjects of lithemia 
and auto-intoxication. The ophthalmic surgeon should be called in 
to remove any irregularities of the respiratory passages. Where 
chronic bronchitis exists between "seasons," this condition should be 
carefully overcome. The most satisfactory results, however, are ob- 
tained by the removal of the patient from the presence of the irri- 
tating causes of the trouble. 

Emphysema. 

Vesicular emphysema is a dilatation of or increase in the size 
of the lung vesicles, characterized by an enlargement or distension 
of the lung, difficulty of breathing, enlargement of the thorax, and 
oftentimes dilatation of the heart. It is a chronic disease that rarely 
proves fatal, but which gives the sufferer considerable discomfort, 
largely due to the associated asthmatic attacks and continued difficulty 
of breathing. Its principle danger is the cardiac changes that take 
place, and in the treatment of emphysema we should take these into 
consideration. Intercurrent attacks of pneumonia demand treatment 
and careful attention along the lines laid down for that disease. Our 
aim should be the reconstruction of the general health as a necessary 
basis and the treatment of the emphysematous condition. These 
cases should be gradually trained to stand tonic hydrotherapeutic 
procedures. Commence the treatment with the electric light bath or 
hot blanket pack until perspiration commences, following this with 
the cold sponge at 70° F., rapidly performed. After two or three 
days of this treatment we may substitute the dripping sheet at 70° 
for three minutes, with vigorous friction, taking care to have the pa- 
tient stand in a hot foot-bath at 110° to 115° F. during its applica- 
tion. As soon as satisfactory reaction has been secured we may adopt 
these measures : The daily use of the electric light or hot-air bath to 
perspiration ; follow this by the horizontal or circular rain bath at 
100° to 104° F. for one and one-half minutes ; reduce the temperature 
to 70° F. for one-fourth minute, twenty pounds pressure ; reduce tem- 
perature one degree daily to 60° F. and increase pressure one pound 
daily until thirty is registered. When these temperatures are reached 
add to the treatment the alternate or Scottish douche to the spine. 
The hot water in this treatment should range from 105° to 110°, the 
cold water 60° F. Give the hot water for ten to fifteen seconds, the 
cold five to ten ; three alternations are sufficient. The alternate or 
Scottish douche has a direct influence upon the emphysematous con- 
dition in the lung, and is a very valuable method of reaching this 
disease. Where there is weakness or irregularity in heart action we 
may apply twice daily the precordial compress, over which the ice- 



270 PRACTICAL HYDROTHERAPY. 

bag is placed. Apply these latter measures morning and night and 
the hydriatic measures in the middle of the day. 

Strasser suggests the use of the trunk compress, half pack at 60° F. 
for thirty to sixty minutes, followed by the half bath at 50° to 60° F. 
Where dilatation of the heart exists the carbon dioxide bath and 
method of resistive exercise, as carried out under the Schott system 
of treatment, will prove a valuable addition in the treatment of this 
complication. 

Tuberculosis. 

Under this heading all forms of tuberculosis are considered, it 
being left to the practitioner to individualize a trifle in the treatment 
of certain conditions peculiar to the different tuberculous processes. 
Tuberculosis is an infectious disease, affecting man and animal. It 
is incited by the bacillus tuberculosis in such cases where, by heredity, 
environment or other means, the tissues are devitalized. It is charac- 
terized by an exudative and productive inflammation, in which ne- 
crosis of the affected tissues is observed. Morphologically, the tissue 
reaction consists of small nodular bodies — tubercles. 

Prophylaxis. — For the tuberculous disease to manifest itself in a 
living organism two things are necessary — presence of the bacillus and 
a condition suitable to its development. The first aim, therefore, should 
be the destruction of the germ and the prevention of an infection. 
As long as the sputum remains in the liquid state there is less danger 
from it, but matter expectorated on the floor, in the street or in a 
handkerchief usually dries very rapidly, and, becoming pulverized, 
finds its way. by inhalation, into the respiratory tract. To this end 
the pocket-flask, when properly and faithfully used by the tubercu- 
lous, proves an immediate factor in the prevention of this disease. 
They should be most thoroughly cleansed by placing the flask, con- 
tents and all, in boiling water to which some bicarbonate of soda has 
been added, where they are left for five or ten minutes. This will 
destroy tubercle bacilli most certainly. The pleasant but unsanitary 
habit of kissing sick people has often led to the transmission of the 
disease from one member of the family to another ; the habit of kissing 
domestic pet animals is equally dangerous. Pathologists handling fresh 
tuberculous specimens, physicians performing autopsies and students 
dissecting, are exposed to the danger of tuberculosis. To walk and 
breathe the atmosphere behind a woman dragging her dress over 
dusty, dirty sidewalks, often clotted with deposits of buccal, bronchial 
and pulmonary secretions containing various pathogenic microbes, at 
other times mixed with tobacco juice, must be dangerous to the health 
of every one. Tuberculously predisposed individuals should be in- 
structed that they may become strong and healthy, and that the acci- 
dental inhalation of tubercle bacilli will not be sufficient to produce 



►-a 



< 



o 



o 




NASO-PHARYNX, LARYNX AND CHEST. 271 

consumption. Those in fair health, living a regular and hygienic life, 
have little to fear. It is the anemic, dyspeptic, toxemic individual, 
of low vitality that makes a candidate for tubercular disease. Every ef- 
fort should be made to secure good appetite and the digestion of plenty 
of simple and wholesome food. Fresh air, sunlight and out-of-door ex- 
ercise are valuable. Alcohol in any of its forms should never be 
used. Resort to the use of cold water, with its stimulating, invigor- 
ating and tonic properties, is one of the best known prophylactic 
measures in existence. It certainly develops vigorous action of the 
vasomotor system, prevents congestion and catarrh, and gives a ro- 
bustness not alone against the tubercular, but any infection. It can be 
instituted at an early age. A child a few months old can support 
with impunity, after the use of its warm cleansing bath, a rapid 
sponging off with cold water, followed by a relatively vigorous fric- 
tion with a soft towel. As growth takes place he should not only be 
taught the use of the cold water after his semi-weekly bath, but each 
morning should bathe the face, neck and chest, "down to the waist," 
with cold water. If access can be had to swimming baths, showers 
or sprays, they should be utilized, winter and summer alike. It 
is my candid opinion that anemic, dyspeptic and toxemic individuals 
who are candidates for consumption can, through a graduated course 
of tonic hydrotherapy, prevent its inception ; in fact, it is with them 
almost a specific. / have yet to sec the individual w/jo could not, by 
a judicious training, be brought to bear vigorous methods; all that 
is necessary is to secure reaction and a gradual education of the skin 
and nervous system. If necessary, start with the cold sponge rapidly 
performed, best by the patients themselves, then the affusion, and last 
the douche. Always follow these methods with friction by the hand 
and afterward with a coarse towel, and what will be said with ref- 
erence to air and sunlight in the treatment of developed tuberculosis 
applies to these individuals. We should always bear in mind what 
Loomis has said upon the question of inheritance : "My experience 
has led me to believe that tuberculous heredity has very little to do 
with the question of a person's recovery, all other things being equal. 
Of twenty persons known to me who have recovered from phthisis 
during the past year alone, nine have pronounced tuberculous his- 
tories. One had two brothers and one sister to die of phthisis." 

The successful treatment of tuberculosis may be conducted in all 
climates. Care must be taken to prevent self-infection by swallowing 
the sputum, and to prevent infecting others by expectorating only in 
pocket-flasks, never indiscriminately. The bed-clothing, knives, forks, 
dishes, and other tableware used by consumptives, must be carefully 
sterilized. The sleeping apartment should be ample and the patient 
must always sleep alone. The bed should be set with the head against 
an inside wall ; the mattress must be hard, and never feathered ; the 



272 PRACTICAL HYDROTHERAPY. 

room well ventilated and kept open most of the time. At night the 
patient should sleep with the window open, rain or shine, cold or 
warm, foggy or clear, wide open in summer, half-open in winter. 

There should never be any fear of night air, for in cities it is 
really purer than in the day time. The room should contain no car- 
pets or hangings. 

As much time as possible should be spent in the open air, as far 
as possible at rest, protected from the wind, keeping the body con- 
stantly in the sunshine. At Falkenstein patients stay out seven to ten 
hours daily in chairs, despite rain, fog, wind, snow, and the thermom- 
eter below zero. While resting in the chair patients may read or write, 
but should endeavor to secure perfect muscular relaxation, for by 
so doing they favor strength and reduce fever. Their lower limbs 
should be covered with lap robes or blankets. As they gain strength 
short walks may be taken, or the patient rise every hour for a short 
breathing exercise. The dress is negligee and comfortable: the under- 
wear light, woolen union suit ; the shirt negligee, the cap ventilated, 
shoes thick-soled and rubber heeled. Women must wear short skirts 
that do not touch the ground, should follow the Lady Huberton, Miller 
style. The divided skirt as an outer dress is often advisable. All 
clothes should be hung from the shoulder; never constrict the waist 
nor interfere with abdominal breathing; corsets are to be avoided, 
but if used must be light, or, what is preferable, a waist. Never con- 
strict the neck or wear tight shoes ; heavy soles, rubber heels for or- 
dinary wear, with gum shoes in cold weather. Men should not be 
permitted to smoke or chew tobacco. 

The diet should be a nourishing one, and the patient really overfed. 
All the food that can be assimilated — that is to say, a mixed diet of 
proteids, carbohydrates and fats — for the digestive power often far 
exceeds the appetite and eating capacity of the patient. Frequent 
feeding has been suggested: Breakfast 7 to 7:30, to consist of bread, 
butter, honey, cocoa or chocolate, and two or three glasses of milk ; 
10 a.m., bread, butter, cold meats, fruits, etc. ; 1 p.m., soups, fish, meat, 
vegetables, salads, preserves, dessert, fresh fruit, and, if necessary, 
a glass of wine; 4 p.m., milk, bread, butter; 7 to 7:30 p.m., soup, pota- 
toes, rice, cold meat, bread, butter, salad, cooked fruit, two glasses of 
milk; 9 p.m., two glasses of milk, and, if necessary, a "pony" of 
cognac. The large use of milk may be made digestible by the use 
of five grains of bicarbonate of soda and five grains salt. Certain 
prepared foods may be added to the above dietary, viz., koumyss, 
plasmon, tropon, etc. 

Hydrotherapy in its action is essentially tonic, and this is what 
the tuberculous person needs. Its aim should be the training of the 
cutaneous and nervous systems to stand low temperatures, followed 
by vigorous and prompt reaction. To accomplish this the treatment 



NASO-PHARYNX, LARYNX AND CHEST. 273 

must be adapted to the individual, and his system gradually educated 
to stand the treatment. It has been the observation of Dettweiler, 
Knopf and other noted therapeutists in this line, that this agent pos- 
sesses a power for good that is almost incalculable. Its action is to 
produce a stimulation of the sensory nerves in the skin, which is 
transmitted to the sensory nervous system, invigorating it and every 
function dependent upon it. The respiration is deepened, nutritive 
processes increased, circulation made more active, appetite and di- 
gestion bettered, and nerve tone strengthened. Another important 
consideration is the "toughening" the skin receives from the appli- 
cation of cold water, as a result of which the neuro-vascular struc- 
tures are stimulated and are enabled to adapt themselves to varying 
conditions of temperature, with the result that the patient does not 
"take cold." 

It has been the writer's plan to commence the treatment with the 
use of dry friction with a coarse towel, once or twice a day — that 
is to say, on arising and retiring. This is followed by the use of mas- 
sage and mechanical vibration. By these preliminary measures we have 
enhanced the reactive capacity of the patient. All hydriatic treatment 
must be given in a warm room. These cases will do better where the 
treatment is preceded by some heating method. In the home we 
may employ the dry full pack, full hot bath at 102° F., or the "home" 
hot-air cabinet until perspiration becomes barely perceptible, fol- 
lowed by a rapid general sponge, commencing at 90° F., reducing 
two degrees daily to 70° F. and one degree daily to 60° F. This is 
best performed in a warm bath-room by the patient himself. Care 
must be taken to prepare the cold water in a bucket beside the tub 
before the bath is entered. "Rub down" with a crash towel till all 
aglow — that is, securing good reaction. This may be used on arising 
or in the forenoon, and at night a stimulating chest compress applied, 
commencing at 80° F. and reducing two degrees daily to 60° F. 
This is to be worn all night. Where a "shower" can be attached to 
the bath-tub it will be found of signal benefit, and should be substi- 
tuted for the sponge as soon as a temperature of 70° F. is reached. 
If the chest compress is not worn it is an excellent plan to rapidly 
sponge the chest and upper trunk with water at 60° just before retiring. 
To increase appetite apply the ice-bag to the epigastric region for 
half an hour prior to the three principal meals. Where much dis- 
turbed by cough the sipping of hot water relieves. In the institutional 
management of these cases we may select the hot air, vapor, or in- 
candescent electric light bath, which latter I much prefer. It should 
be administerd for a short period and stopped at the commencement 
of perspiration ; under no circumstances should profuse perspiration 
be induced. As soon as the patient is sufficiently warmed he is re- 
moved from the electric light bath and given a preliminary treatment 



274 PRACTICAL HYDROTHERAPY. 

(rain bath or douche) of warm water, followed by the cold treat- 
ment. Commence with the sponge at 80° F., rapidly reducing two to 
three degrees F. daily to 65° F., paying especial attention to the apices 
and spine, followed by vigorous friction and good reaction. Next 
move to the circular needle rain bath at 100° F. for one minute, re- 
duced to 65° F. for ten to fifteen seconds. Now institute the full 
daily treatment as follows: Electric light bath till perspiration com- 
mences ; circular needle rain bath at 100° F. for one minute ; fan douche, 
65° F., to entire body ten seconds ; jet douche to legs, spine and apices, 
front and rear, ten seconds. During the application of the cold 
water it is a good plan to have the mouth open wide in order that 
deep respirations may be taken, and to move the arms, legs and chest, 
as this will reduce the shock of the impact of cold water and favor 
reaction. The treatment should be finished with good friction in a 
warm room, first with the hand and afterward with a Turkish towel. 
Knopf suggests using the douche first on the feet, rapidly passing 
up to the hips, and spray over the body. I have found this an excel- 
lent plan, and usually finish the treatment, where the patients are 
able to stand it, with the jet to the apices and up and down the spine. 
The patients should be frequently weighed, a gain in weight indi- 
cating success and loss a failure to adapt hydriatic methods to the 
case. The best time for the bath is the morning hours, and each treat- 
ment should be followed by a lunch. In some cases I have found it 
advisable, when their reaction is well developed, to follow the elec- 
tric light bath directly by the cold water treatment, better response 
being thus obtained. A chilly sensation after the bath should indi- 
cate a change in temperature and duration. 

Baruch, 7 in speaking of the forlorn cases that come to the Monte- 
fiore Home for chronic invalids, says that he has been led to adopt 
the following course, because the skins of many of these poor people 
have long been strangers to cold water, or, indeed, water of any kind: 

"After the thorough cleansing with a warm bath or soap ablution, 
a day is allowed to elapse. The patient is now wrapped snugly, quite 
naked, in a woolen blanket, so that his body is excluded from the air; 
other blankets are piled over him, the windows are opened and he is 
given a small glass of iced water every ten minutes. Having lain in 
this position an hour, a part of the body is exposed and bathed, as 
follows : With a towel the face is bathed in water at 50° F. ; a basin 
of water at 75° F. is made ready, into which the attendant dips his 
right hand, covered by a mitten or glove of Turkish toweling. One 
arm having been exposed, it is rapidly washed and rubbed with the 
wet glove dipped in water at 75° F., then dried and replaced under 
the blanket. Other parts are successively treated. At the termination 
of this ablution the patient is rapidly rubbed with a coarse towel. 
This treatment is repeated daily, the temperature of the water being 
reduced two degrees on each occasion until 60° is reached. The 

7 Baruch. Simon: "Hydrotherapy," 1906, p. 351. 



o 



X 

o 
c 



o 



n 



o 

3 
















/7* 



NASO-PHARYNX, LARYNX AND CHEST. 275 

dripping sheet is now indicated. The result is usually an improved 
appetite, better digestion and assimilation, improved hematosis, 
deepened respiration, vigorous circulation — in brief, an enhancement 
of all those functions which contribute to the maintenance of health 
and on whose integrity depends the prolongation of life." 

Morris 8 says that a certain number'of cases fail to respond to 
treatment because of the heart weakness present. Upon examination 
they will be found to have a dilated heart, high pulse-rate and tem- 
perature. In these cases a valuable adjunct to the general manage- 
ment of cases is the Nauheim bath, applied as though we were treat- 
ing the cardiac condition alone. His results were excellent. The 
dilatation lessened, pulse-rate and temperature declined and arterial 
tension rose. In two cases, in the incipient stage, the author has 
himself seen the cardiac condition clear up and the pulmonary lesion 
improve. Subsequent treatment "cured" the cases. 

Certain symptoms prominent in the disease can be treated satis- 
factorily by hydriatic methods. Tuberculous pyrexia demands spe- 
cial management — absolute rest in bed, in a well-ventilated room, 
with as much fresh air as possible ; internal administration of cold 
water, lemonade or orangeade. The rule should be that the higher the 
temperature the more tepid the water. We should start with a par- 
tial and then an entire cold sponge. Winternitz 9 suggests water at 
65° to 55° F., sponging the parts in the order named: Hands, fore- 
arms, face, throat, neck, arm-pits, back, stomach and lower extremi- 
ties. The parts should be exposed as little to the air as possible, 
should be sponged and dried rapidly ; repeat three to four times daily. 
We may next proceed to the use of the cold compress or a partial 
pack, applying first to the legs and then to the arms, or alternating 
every hour. Where there is the slightest tendency to cardiac col- 
lapse the ice-bag should be applied to the precordia. The cold enema 
oftentimes reduces temperature nicely. 

Cough and night-sweats are best prevented by rest, sleeping in a 
cool room, with plenty of fresh air, light bed-clothes and the wearing 
of no underwear in bed. The chest compress is the best method, 
being careful to cover the apices thoroughly, using water at a tem- 
perature of 55° F., the compress being covered by a flannel compress 
and remaining on all night. In the morning remove the compress 
and quickly sponge the chest with water at 60° F., followed by fric- 
tion. This same treatment will help to overcome the insomnia and 
restlessness often found in these cases. 

Climate alone will never cure phthisis, and as the vast majority 
are among those who cannot afford trips and long sojourns, it stands 

8 Morris, Geo. W. : American Medicine, February, 1907. 

9 Winternitz, Wm. . "Hydrotherapy," Cohen's system of Physiological Therapeutics, Vol. 
IX, 1902. 



276 PRACTICAL HYDROTHERAPY. 

to reason they must follow out a strict and rigid treatment and disci- 
pline, no matter where they may be. I have seen "lungers" on the 
Riviere, at Monte Carlo, Nice, and other Mediterranean resorts, 
smoking, gambling and living unhygienically under the fatuous be- 
lief that climate would effect a cure. It is certainly a comforting doc- 
trine and reassuring to those who cannot get away, that the tubercu- 
lous patient, of whatever country or race, can be suitably treated not 
far from his own home. 

Education and discipline are paramount factors in the treatment. 
The tuberculous may aid in their recovery by practicing breathing 
exercises, and by changing their underwear if they perspire much. He 
should never leave the house before sunrise and remain in-doors 
during sunset ; retire very early, never read in bed, and secure nine 
hours' sleep if possible. Cheerfulness and happiness, with a willing- 
ness to follow out all that science has learned with regard to what 
is good for his disease, will enable him to make a recovery which 
otherwise would be impossible. 

Summed up in a nutshell, the ideal treatment of the tuberculous 
patient consists in having him live in a high, elevated and dry climate, 
residing in a tent or tent-house, within easy access of a central insti- 
tution, where he may obtain proper and nutritious diet and hydro- 
therapeutic treatment, with facilities for pleasant rides and drives, 
unexciting games and such companionship with books and friends 
as will prevent too great intrusion of ennui and self. 

The influence of hydrotherapy is to stimulate, in an unparalleled 
manner, nervous function, to relieve congestion and develop a neuro- 
vascular power equalled only by active muscular exercise. It deep- 
ens respiration, increases the oxygenating power of the blood, favors 
the elimination of carbon dioxide and other waste materials. It in- 
creases appetite and digestion, and as a result more food is taken and 
assimilated, and thus a gain in flesh is possible, while at the same time 
reparative factors are removing the diseased process and making 
good the damage already done, for by means of increased circulation, 
by nerve action and increased oxygenation, waste products are de- 
stroyed and more rapidly removed from the system. Every gland 
in the body is stimulated, and by this means better and more active 
glandular products produced. Its energizing influence upon the heart 
and blood-vessels causes an increase of blood circulation, the removal 
of stasis, congestion and- inflammation, wherever they may be ; this I 
have seen time and again in all classes of patients. It checks night- 
sweats, reduces cough, favors expectoration and relieves temperature. 
It will thus be readily seen that it sets in action the entire tissues and 
structures of the patient that are essential to the maintenance of 
health and physical integrity. 



NASO-PHARYNX, LARYNX AND CHEST. 277 

Prevention of Acute and Chronic Respiratory Inflammations. 

The basic treatment in the prevention of these inflammations, or, in 
fact, any other form of inflammatory disturbances of the human sys- 
tem, is to gradually train the cutaneous blood-vessels to stand varying 
changes in temperature and moisture, and this is largely a matter of 
training the cutaneous nervous system to withstand impressions that 
would otherwise markedly influence the vasomotor centers. Nearly 
all those who are unusually susceptible to those influences that pro- 
duce inflammation are the subjects of lowered vital resistance and 
live under vitiating influences. For this reason we should use 
every means that will improve the general nutrition, especially keep- 
ing in mind that the digestion and elimination are two factors never 
to be lost sight of. Moderate eating, the free use of fruits, the drink- 
ing largely of plain or carbonated water, the regulation of constipa- 
tion and the insistence upon normal nose-breathing are essentials. 
Nothing in the range of medicine equals cold water as a preventive 
measure. Where individuals have no access to institutional treat- 
ment we may insist upon their using cold water twice daily. In the 
morning the rapid cold sponge at 60° F. over the entire body, or the 
cold shower at 60° F. for ten to fifteen seconds, followed by a brisk 
rub down with a rough Turkish towel, together with the use of a few 
free hand exercises, will be found a most satisfactory measure. In 
the afternoon or evening, if he can secure a swimming bath, it will 
be found most advantageous, but where this is not possible the same 
treatment may be again repeated in the evening. In large cities the 
Turkish bath may be used in conjunction with the bath treatment 
once weekly. 

Institutions and sanatoria find the electric light bath to the point 
of perspiration, followed by certain tonic hydriatic measures, the most 
satisfactory. Commence with the electric light bath until free perspi- 
ration takes place, followed by the horizontal rain bath at 102° F. 
for one and one-half minutes, reduced to 70° F. for one-fourth to one- 
half minute, twenty pounds pressure. Reduce temperature one to two 
degrees daily until 60° F. is reached and increase pressure two pounds 
until thirty is registered; follow by the cold foot-bath, 60° to 50° F., 
for one-fourth to one-half minute. As soon as the patient is able 
the following roborant measures will be found most satisfactory: Elec- 
tric light bath to free perspiration ; horizontal rain bath at 104° F. for 
one and one-half minutes, followed by the fan douche to the entire 
body and jet douche to the spine, each one-fourth minute at 60° F., 
thirty pounds pressure; cold foot-bath at 50° F. one- fourth minute. 

Pleuritis. 

Pleurisy, or "stitch in the side," is an inflammation of the pleura 
characterized by a sharp pain in the side, dry cough, dyspnea and 







278 PRACTICAL HYDROTHERAPY 

fever. It may be acute or chronic, local or general, and involve one 
or both sides. It most frequently occurs secondarily to other dis- 
eases. Local conditions occur from localized influences such as 
trauma or local diseases. The disease usually terminates in recovery, 
though this, of course, depends upon the causal influences that exist. 
Hydrotherapy is one of the most valuable treatments that can be 
used in connection with this affection, and the success that it has 
attained in the hands of experts can be duplicated by the general 
practitioner if he exercise a little patience and ingenuity. In the 
treatment of this affection the patient, of course, should be put to 
bed and kept there. The diet should be restricted to liquids and 
water drunk freely. It is an excellent plan to commence the treat- 
ment with a good-sized dose of calomel, followed by a saline, though 
this should not delay the immediate application of hydrotherapeutic 
measures. Broad strips of adhesive plaster are applied to the affected 
side to secure, as far as possible, physiological rest, and where this 
is necessary it may be applied and hydrotherapeutic measures used 
over the strips. During the earlier stages of the disease begin the 
treatment with the application of a fomentation at 120° to 150° F. 
for ten minutes to the affected side or spot beneath which the friction 
murmur is heard. As soon as this is removed apply the stimulating 
chest compress at 65° to 60° F., seeing that the bandage over the 
compress is drawn very tight. This should remain in position for 
one or two hours, depending upon the case, when it can be removed 
and the entire step of fomentation and compress repeated. It is 
often an excellent plan to place over the compress a broad flat ice-bag 
or Leiter coil through which is passed water at a temperature of from 
60° to 50° F. The chest compress and ice-bag exert an antiphlo- 
gistic effect, relieve pain and prevent exudation. Oftentimes good 
can be accomplished by the application of the full wet pack at 70° F. 
for one to two hours, followed by the half bath at 65° F., accom- 
panied by friction. When exudation takes place we may continue 
the same treatment as recommended during the dry stage, although 
it will be found especially valuable at this time to use the full wet 
pack of one or two hours' duration. During the stage of absorption 
it becomes necessary to remove the serous exudate and build up the 
general health. Where this exudate is large it is probably best to 
aspirate same and follow with the treatment hereinafter suggested. 

We may commence with the daily use of the electric light bath 
or hot-air bath to the point of perspiration, followed by the dripping 
sheet at 70° F. for three minutes, with vigorous friction, reducing 
water two degrees daily until 60° F. is reached. This treatment may 
be supplemented by the use of the stimulating chest pack at 65° F., 
tightly applied and repeated every three hours. As soon as reactive 
and other capacities of the patient justify we may institute the 



NASO-PHARYNX, LARYNX AND CHEST. 279 

following: Electric light bath or hot-air bath to the point of mod- 
erate perspiration ; follow this with the horizontal or circular rain 
bath at 100° to 105° F. for two minutes, reduced to 70° F. for one- 
half minute, pressure twenty pounds. Decrease temperature two 
degrees daily until 60° F. is reached and increase pressure two pounds 
daily until thirty is registered. 

In chronic pleurisy we may have recourse to the following treat- 
ment, that has proven in a number of instances most satisfactory to 
the author: Electric light bath until free perspiration; circular rain 
bath at 105° F. for one and one-half minutes, reduced to 60° F. for 
one-fourth minute, pressure thirty pounds. This should be followed 
by the Scottish jet or fan douche to the affected side, the hot water 
at a temperature of 105° to 110° F. for one-half minute, cold from 
70° to 60° F. for ten to fifteen seconds. The number of alternations 
should range frorn two to five. Judgment must be exercised in the 
use of the Scottish douche to the chest, and it is best in these cases to 
commence with the fan douche under very moderate pressure — ten 
to fifteen pounds — and by gradually accustoming the patient to the 
percussory influence of the douche reach the stimulating measure of 
the jet — under twenty to twenty-five pounds pressure. 

In connection with the treatment of chronic pleurisy by hydro- 
therapy much advantage will be gained from the use of those gym- 
nastics that have for their object the expansion of the thorax and 
the activity of the thoracic muscles. The patient should be taught, 
in addition, to frequently breathe deeply through the nose, retaining 
the air within the chest so as to stretch the chest wall thoroughly. 
Associative measures of some value in relieving, promoting absorp- 
tion and preventing adhesions, will be found in the galvanic current 
and massage. Should a purulent collection accumulate excision of 
the rib is the proper procedure, securing free drainage for the pleural 
sack just as we would for any abscess cavity. Iodide of potassium, 
quinine and iron are good adjuvants. 



CHAPTER XIV. 

DISEASES OF THE PERITONEUM AND LIVER; RHEUMA- 
TISM; GOUT; DIABETES; OBESITY; RACHITIS. 

Peritonitis. 

Peritonitis is an inflammation of the peritoneum, characterized 
by intense pain, tympanites, vomiting, fever and great prostration. 
Its origin is usually microbic, entrance being gained usually by trau- 
matism within the bowel, although cases have been reported where 
it has been believed that they have migrated through inflamed in- 
testinal walls. Where ulceration, perforation and rupture take 
place the inflammation results from the same causes that produce 
the original disease. The micro-organisms most commonly found 
are bacillus coli communis, staphylococcus aureus and albus, bacillus 
pyocyaneus, tubercle bacillus and the gonococcus. This latter germ 
usually gains entrance into the peritoneum from the Fallopian tubes. 
The treatment is both medical and surgical, and in the opinion of the 
author a surgeon should be at once summoned, as the question of 
operative procedure early in these cases is a factor not to be disputed. 
The disease compels rest in bed ; the diet should be absolutely liquid — 
albumen-water, thin soups, gruels of arrow root or barley, dry cham- 
pagne, etc. The patient should be given salines until free catharsis 
is secured, one to two drachms every two to three hours. Vomiting 
is best met by the administration of pellets of ice, Vichy water and 
the like. Tympanites is often overcome by the use of high enemata 
of warm saline, to which a little turpentine has been added. Where 
the fever is high the temperature of the enema should be 80° F. 
Cardiac weakness, which always accompanies the disease, is most 
satisfactorily combated by the systematic use of the precordial com- 
press over which the ice-bag has been placed, being applied for fifteen 
to twenty minutes four to five times daily. Hydrotherapy is of some 
service. A fomentation at 115° to 120° F. for ten minutes may be 
repeated for the same length of time and followed by the stimulating 
cold compress at 60° F. for thirty minutes to two hours, with an 
ice-bag or coil over the region most affected, and will sometimes in- 
crease the vital strength of the patient, reduce pain and cause a cessa- 
tion of vomiting. 

The author is constrained to believe, however, that these are 
280 



DISEASES OF PERITONEUM AND LIVER. 281 

more or less temporizing or adjunct procedures, and that surgical 
intervention is of the most service in this disease. In the chronic 
form we have to do with an inflammation that is usually tuberculous, 
cancerous or syphilitic, and in the management of this most difficult 
problem we should have recourse to the sections in which these dis- 
eases and their treatment are discussed. The dietary in the chronic 
cases should be most carefully arranged to avoid as far as possible 
fermentation and the generation of gas. Free water drinking is 
indicated. We may have recourse to enemata and mild laxatives 
to overcome any tendency to constipation. Sometimes the foment- 
ation for fifteen to twenty minutes three times daily, followed by the 
stimulating cold compress well protected, gives some gratifying relief. 
During the stage of convalescence from peritonitis rest in bed, con- 
centrated diet and the gradual administration of tonic hydrothera- 
peutic measures, such as the dripping sheet and the horizontal rain 
bath, may be utilized. 

Ascites — Dropsy — Anasarca. 

Ascites is a collection of serous fluid in the peritoneal cavity 
characterized by a distended abdomen, dullness on percussion, fluctua- 
tion and difficult breathing. It may collect in small or enormous 
quantities, the author having seen several cases in which quantities 
have been removed far in excess of ordinary belief. It usually has 
back of it a causative condition arising principally in the heart, kidney 
or liver. Cancer is sometimes its cause, and it may be safely stated 
that where ascites exists in the presence of a tumor, and blood in any 
great quantity in the fluid aspirated, points to a diagnosis of this 
disease. It stands to reason that ascites, being more or less symptom- 
atic, requires a consideration in its treatment of the particular disease 
that may be the agent causing the condition. To accomplish the dis- 
appearance of the fluid, diminish its secretion and stimulate its ab- 
sorption, water-drinking may prove useful, but its administration must 
be carried out on the following lines : The free ingestion of cold 
water is allowed and then a period of six or eight hours must inter- 
vene before any other fluid is taken. Under this procedure it will be 
found that the blood becomes more consistent, more impoverished 
in water, and therefore takes up water from the tissues and abdom- 
inal cavity. It is not only true that the administration of water in 
this way increases the elimination of the liquids of the body, but it 
also carries with it the solid products of inflammation and the ex- 
udates contained in the fluid. Cold water has a direct diuretic effect, 
and while, generally speaking, water-drinking is not indicated in 
nephritic cases, even in these its use, as above directed, will be found 
advantageous. Where it is due directly to cardiac insufficiency the 
precordial compress, over which a coil of cold water or an ice-bag 



282 PRACTICAL HYDROTHERAPY. 

has been placed, will materially aid in the removal of the effusion. 
In this respect the ice-bag has an action analogous to digitalis, raising 
arterial pressure and stimulating the circulation. Hydrotherapy is 
of unquestioned value. We may use the hot-air bath, electric light 
bath, or, what is by far the most satisfactory of all measures, super- 
heated dry hot air applied by means of the body apparatus. The 
patient should be placed in this apparatus only as far as the arm-pits. 
The temperature should range from 200° to 300° F., and the treat- 
ment from twenty to sixty minutes. During its application the head 
should be kept cold by means of a wet turban or ice-cap and com- 
press, and the ice-bag placed over the heart. This treatment must 
be repeated daily. In two cases the author has seen benefit after the 
second bath. No cold applications are to be made after this treatment 
until evidence of diminution of the dropsy is present. It is some- 
times best to tap the patient and follow the tapping with the treatment 
here outlined to prevent reformation. Where access cannot be had 
to the apparatus mentioned, we may employ the wet half pack from 
the arm-pits down at a temperature of 70° F. for one to two hours, 
repeated twice daily. The abdominal compress at 65° F., or circular 
compress to the limbs and swollen parts, will oftentimes prove of 
considerable value as a means of giving comfort and relief to the 
patient. The pack and compress may be combined, giving the pack at 
65° to 70° F. for an hour, and in the interim applying abdominal 
and circular compresses at 65° F. to the affected parts. Sometimes 
friction with a dry cloth alone will stimulate absorption, but in any 
event it should be utilized after the hydriatic measures suggested. 
It will usually be found that these treatments result in increased 
power and diminished work on the part of the organs affected. We 
find that the heart is invigorated, its systole strengthened, its diastole 
lengthened, with a better pulse and an increased arterial tension, due 
to better muscular state in itself and in the arteries. 

As convalescence takes place we may in these cases institute 
carbon dioxide baths or tonic procedures as follows: Hot-air or 
electric light bath to perspiration, followed by the dripping sheet at 
70° F. for three minutes with vigorous friction, reducing the tem- 
perature one degree daily until 60° F. is reached. At this time we 
may institute the electric light bath to free perspiration, followed by 
the circular or horizontal rain bath at 105° F. for one and one-half 
minutes, reduced to 70° F. for one-half minute, pressure twenty 
pounds. Diminish temperature one degree daily until 60° F. is 
reached and increase pressure one pound daily until thirty is regis- 
tered. Later we may add to this treatment the Scottish douche at 
110° F. for twenty seconds, followed by a temperature of 60° F. 
for five seconds, three alternations, applied to the lower spine and 
legs. 



DISEASES OF PERITONEUM AND LIVER. 283 

Hepatic Congestion. 

This condition of so-called "biliousness" is an abnormal fullness 
or engorgement of the vessels of the liver, characterized by disorder 
of the digestive functions, sallow color, coated tongue, foul breath 
and mental torpor. The liver is usually tender to palpation. This 
condition originates most frequently in the disobedience of those 
hygenic laws that all should follow, is brought about by errors and 
excess in eating and drinking, especially where malt or alcoholic 
liquors are added to the excessive food. Chronic indigestion and 
habitual constipation are causes that are exceedingly common, and 
demand consideration at all times by the hydriatist in his manage- 
ment of these cases. The aim should be to overcome the acute attack 
and prevent its return. During the attack we may administer a 
pretty good dose of calomel and follow it with a saline, but should 
the patient remain very much upset a more rapid way of relief is 
to wash the stomach, removing all fermenting material ; also giving 
a high enema of soap and water. After this much relief will be 
gained from the application of the fomentation, repeated as fre- 
quently as is necessary. It may be confidently stated that where 
the congestion is not due to organic changes hydrotherapy is 
a most efficient method for permanent relief. These cases are 
nsually more or less robust, and we may at once commence the 
admininstration of full treatment. Give the electric light bath or hot- 
air bath until free perspiration takes place, following this with the 
horizontal or circular rain bath at 105° F. for one and one-half 
minutes, reduced to 70° F. for one-half minute, pressure twenty 
pounds. Increase pressure one pound daily until thirty is registered. 
At this time we may place these cases on the following very active 
treatment: Electric light bath or hot-air bath until free perspiration; 
circular or horizontal rain bath at 105° F. for one and one-half min- 
utes; fan douche over the liver and abdomen, jet douche to the spine 
for one-fourth minute each, temperature 70° F Commence the 
pressure at fifteen to twenty pounds and gradually increase to thirty; 
reduce temperature one degree daily until 60° F. is reached. Should 
constipation be present recourse should be had to the dietary and 
general measures suggested under that head. In these cases the 
Turkish bath has won for itself a reputation that is well justfied, and 
the only regret is that these baths are not more frequently under the 
charge of intelligent people who could administer them suited to the 
individual case. Where intelligently and carefully applied the writer 
can testify to the benefit to be derived from them by sufferers from 
this condition. 



284 PRACTICAL HYDROTHERAPY. 

Catarrhal Jaundice. 

Icterus is not a disease, but a symptom-complex group, of an 
acute catarrhal inflammation of the mucous membrane of the bile- 
ducts, and characterized by gastro-intestinal derangements, fever, 
mental depression and sallowness of the skin. While these cases are 
not generally considered obstructive, still they are in all probability 
more or less so. The patient should at once be put in bed and placed 
at rest and the diet limited to liquids, of which milk and lime-water, 
milk, peptonized milk, buttermilk, whey, raw eggs and broths of beef, 
chicken, etc., are the type. As improvement takes place we may add 
milk toast, arrow root, boiled rice, oysters, meat jellies, fish, scraped 
meat, squab, chicken and soft-boiled eggs. Little sugar, fats and 
starches should be eaten. Free hot-water drinking is essential, and 
with this we may utilize the Carlsbad water, as suggested by numerous 
authors, two glasses of which may be drunk at least half to three- 
quarters of an hour before breakfast. It is of comparatively little 
value, except for the relief of the intestinal condition. The Rock- 
bridge alum water sometimes acts better. Local treatment to the 
bowel is oftentimes of great service, especially high enemata of cold 
water two or three times daily, using about one quart of water at a 
temperature from 60° to 65° F. Small, very cold, low enemata at 
50° F. twice daily, or a small piece of ice introduced into the rectum, 
are of undoubted value, causing a freer flow of bile and a relief of 
the inflammatory condition through reflex influence upon the upper 
intestine and gall-bladder. Where there is much pruritus we may 
employ the very hot sponge at 110° to 120° F., to the water of which 
sodium bicarbonate, three drachms to the pint, has been added. 
Especially valuable in this connection is the neutral bath to which 
sufficient sodium bicarbonate or potassium carbonate has been added 
to render it alkaline. Where much pain exists we may apply the 
very hot fomentation (120° to 130° F.) for ten minutes, immedi- 
ately repeated for ten minutes and followed by the abdominal com- 
press at 60° F., worn for three hours, at the end of which time we 
may again repeat the process. As soon as the patient is able to stand 
tonic measures they should be instituted. Commence with the drip- 
ping sheet at 70° F. for three minutes, with vigorous friction, followed 
by the cold sitz bath at 60° to 65° F. for five to ten minutes. As 
soon as reactive capacity is established we may commence with the 
electric light bath or hot-air bath until free perspiration takes place, 
followed by the dripping sheet at 60° F. and the sitz bath as above 
described. After a few days' treatment we may then try the following 
treatment, which has proved very satisfactory in the hands of the 
author: The electric light bath or hot-air bath until free perspira- 
tion takes place, followed by the circular or horizontal rain bath at 



DISEASES OF PERITONEUM AND LIVER. 285 

105° F. for one minute and a half, this to be followed by the fan 
douche to the entire body and the jet douche over the liver region. 
The pressure should be started low — fifteen pounds — and gradually 
increased daily until twenty-five or even thirty pounds is registered. 
The fan and jet douche may be commenced at a temperature of 
70° F., reduced one degree daily until 60° F. is reached. To this 
treatment every other day, or, what is more preferable, at some other 
time during the day, may be added the sitz bath at 60° to 65° F. for 
five minutes. 

Cholelithiasis; Acute Infectious Cholecystitis; Cholangitis. 

Biliary calculi, hepatic colic, usually originate from concretions in 
the gall-bladder or biliary ducts. These stones are formed partly or 
entirely from the constituents of the bile, and their presence is not 
recognized until they attempt to pass from the gall-bladder through 
the common duct into the intestine, the result of which passage is an 
attack of colic. Bacteria act as causative agents by producing inflam- 
mation, and in the case of cholecystitis the origin is strictly bacteric. 
The stones are brown, spherical, ovoid or polygonal, their particular 
constituent being cholesterin. They may become a cause of other 
troubles, such as perforation, suppuration, peritonitis and hepatic 
abscess. The rule is that uncomplicated cases recover. During the 
attacks we may apply the very hot fomentation (130° to 140° F.), 
followed by the very hot compress for twenty to thirty minutes, re- 
peating these as often as necessary to gain relief. Some writers 
have found the hot full bath,- as hot as can be borne, an excellent 
method by means of which the patient may be relaxed and the pain 
relieved. An excellent method is the use of the hot trunk compress 
with the hot-water coil or bag upon the outside to maintain the 
temperature. The patient may be instructed to drink freely of very 
hot water. Should this be vomited the drinking must be continued, 
as it will tend to allay vomiting and stop the pain. During the 
intervals we may continue the use of free water-drinking and the 
administration before breakfast of sodium phosphate or Carlsbad 
water. 

The experience, however, of the last two or three years seems to 
indicate that it is possible to remove calculi in the most difficult cases 
with comparative safety, provided the patient be not allowed to become 
too much poisoned by intestinal toxins, the toxins of the bile and 
those resulting from membranous infection. It may therefore be 
considered that, given a reasonable certainty of gall-stones, we may 
employ the knife, as the operation is fairly safe. Operation does not, 
however, insure against the reformation of gall-stones. It simply 
removes existing stones, cleanses the ducts, and favors free exit of 
the bile. For this reason we should, during convalescence, and for 



386 PRACTICAL HYDROTHERAPY. 

many months after an operation for biliary calculi, place the patient 
upon treatment that will have for its object the restoration of the 
general health, the increase of vital resistance, the prevention of 
stagnation of the bile and better general intestinal conditions. The 
diet at this time should be such as to avoid farinaceous and fatty 
foods, at the same time eliminating vinegar, spices, pastry, tea, coffee, 
alcohol, etc. The correction of sedentary habits should be insisted 
upon. The three best exercises, in my opinion, are horseback riding, 
bicycling and bowling. These exercises involve the activity of the 
abdominal muscles, which by their movement tend to act as a suction- 
pump in removing the thickened biliary secretions. 

Here again we should insist upon the free ingestion of water. Two 
tumblers of Carlsbad water at 140° to 150° F. before breakfast and 
free drinking of plain water during the day must be insisted upon. 
These cases, after operation, are usually much prostrated, and need 
a continuous up-building for long periods of time, and nowhere in 
the range of therapeutics will be found a better method than hydro- 
therapy. Commence with the dripping sheet at 80° F for three 
minutes, with friction, taking care to have the patient stand in a 
foot-tub of hot water during its application. Reduce the temperature 
one degree daily until 70° F. is reached. At this time the patient's 
reactive capacity will enable us to proceed to the next step: — the 
electric light bath or hot-air bath to free perspiration, followed by 
the circular or horizontal rain bath at 105° F. for two minutes, re- 
duced to 70° F. for one minute, pressure twenty pounds. Decrease 
temperature one degree daily until 60° F. is reached and increase 
pressure one pound daily until thirty is registered. If any discomfort 
is felt over the site of the operation have the patient protect the 
same with the hand. At this stage give the electric light bath or hot 
air bath until free perspiration, followed by the circular or horizontal 
rain bath at 105° F. for one and one-half minutes, this in turn to be 
followed by the fan douche to the entire body and the jet douche to 
the liver at 70° F for one-fourth minute each. The pressure in this 
treatment should be started low — fifteen pounds — and very gradually 
increased until twenty to twenty-five pounds is registered. The tem- 
perature may be reduced one degree daily until 60° F. is reached. 
Adjunct measures that will be found of distinct value in these cases 
are the use of massage and the application of the static wave current 
over the hepatic region. A combination of these measures sometimes 
produces astonishing results. 

Hepatic Cirrhosis. 

Cirrhosis of the liver is an inflammation of the connective tissue 
of that organ, chronic in its progress, producing induration, followed 
by atrophy of the liver cells, characterized by slight jaundice, emacia- 



DISEASES OF PERITONEUM AND LIVER. 287 

tion, gastro-intestinal catarrh and ascites. The causative factor of 
the disease is generally the long-continued and daily use of alcohol, 
although the method of its action upon the liver connective tissue is 
unknown. It would seem from recent investigations and experience 
that alcohol, with its disturbing influence upon the stomach and in- 
testine, generates a favorite nidus for toxins. If this be true — and 
it is now most generally accepted to be true — treatment in the early 
stage should be very effective in the arrest and prevention of the 
disease. No claim, of course, can be made for the removal of cirrhotic 
tissue, but functional activity may be preserved and symptomatic 
cure obtained. The patient should be instructed to live as much as 
possible an out-door life, and to exercise along those lines that will 
most influence the abdominal and trunk muscles. For this reason 
horseback riding, rowing, bowling and gymnastic movements for the 
trunk are very valuable. The diet should consist of bouillon, soups, 
milk, custard, vegetables, such as string beans, peas, potatoes, mashed 
or baked, lettuce, tomatoes, turnips, spinach, greens, etc. Meats 
should be eaten in great moderation, the white ones being preferred, 
especially chicken, squab, turkey, fish, etc. All forms of alcohol, 
together with spices, teas, coffee, fried food, pastry, etc., should be 
interdicted. Especial care should be taken to maintain an equable 
body heat and the avoidance of cold and fatigue. Water may be 
freely drunk, especially the alkaline and alkaline carbonated waters, 
Carlsbad water before breakfast, very hot, or some form of saline 
purgative, is useful. In case of ascites tapping should be done. In 
this disease the electric light bath seems to exercise a very beneficent 
action and oftentimes is of surprising benefit. In this respect it 
resembles the sun bath, with regard to which clinical observations 
have shown it to be a powerful factor in degenerative conditions in 
abdominal viscera. The arc light bath, especially where concentrated 
over the liver, is an excellent method of treatment, and may be com- 
bined, if so desired, in simultaneous use with the electric light bath. 
Commence the treatment with the electric light bath to free perspira- 
tion, followed by the rain bath at 105° F. for one and one-half 
minutes, reduced to 70° F. for one-half minute, pressure twenty 
pounds. Decrease the temperature one degree daily until 60° F. is 
reached and increase pressure one pound daily until thirty is regis- 
tered. This should be followed by the cold sitz bath at 50° to 60° F. 
for five minutes. As soon as the patient reacts well we may proceed 
to the following full treatment : Electric light bath to free perspira- 
tion, followed by the circular or horizontal rain bath at 105° F. for 
one and one-half minutes, followed by the fan douche to the entire 
body for one-fourth minute and the jet douche over the liver for 
one-fourth minute. The fan and jet douche should be commenced 
under low pressure — ten to fifteen pounds — and daily increased until 



■^ 



288 PRACTICAL HYDROTHERAPY. 

twenty or twenty-five pounds is registered. The temperature should 
start at 70° F. and be reduced one degree daily until 60° F. is 
reached. There is no question whatsoever that the cold jet douche 
is one of the most powerful and effective means of stimulating the 
liver. It increases its circulation and functional activity, but before 
these effects are noticeable it must reach a point of considerable 
pressure. In some cases we may advantageously terminate the treat- 
ment with the Scottish douche over the liver, especially if any pain 
is experienced. The temperatures of the Scottish douche should 
range between 110° F. for thirty seconds and 60° F. for five to ten 
seconds, alternating three to four times. In cases that are feeble or 
confined to the bed the fomentation applied over the liver will some- 
times give great comfort and relief even in advanced cases. It should 
be followed by the cold compress. 

In this disease the author would again recommend the added use 
of massage, static sparks over the liver and the galvanic current. 

Acute Articular Rheumatism. 

Rheumatic fever is a constitutional, migratory disease, charac- 
terized by fever, non-suppurative inflammation in and around the 
joints, acid sweating, and a tendency to inflammation of the endo- 
and pericardium. The origin of the disease is supposed to be a 
micro-organism, probably a diplococcus, infectious in character, al- 
though the germ has not as yet been successfully isolated and cul- 
tivated. There is no question but what exposure to damp, cold, and 
sudden changes in the atmosphere, especially in those who are of 
lowered vitality, tend to produce the disease. It is rare in the ex- 
tremes of infancy and old age. It is essentially an exudative in- 
flammation in synovial membranes and ligamentous tissues. There 
is an increased quantity of lactic acid present in the system, but the 
exact relation of this as to cause and effect is unknown. The fever, 
usually 102° to 104° F., in some cases is raised to 108° to 110° F., 
constituting the dangerous rheumatic hyperpyrexia, at which time 
cerebral symptoms of delirium are usually present. It is prone to 
attack joints on the same side of the body. Rheumatism per se 
is not a dangerous disease, the danger arising from inflammations 
of the cardiac membranes. There is no tendency on the part of 
rheumatism toward recovery, and relapses are frequent. The mor- 
tality is very low, ranging from 0.3 to 0.5 per cent., recovery being 
the rule. Treatment should have for its object four purposes: (1) 
Combat the inflammation, (2) encourage elimination, (3) relieve 
pain, and (4) prevent cardiac and cerebral complications. These 
indications are, in my opinion, best met by the combined use of hygiene, 
hydrotherapy and the salicylates. 

The patient should at once be placed in bed at absolute rest. The 



RHEUMATISM. 289 

garment de nuit must be woolen, and the patient lie as far as pos- 
sible between blankets and avoid the use of sheets. The bed-clothing 
should be only sufficient to keep him warm, and should the inflamed 
joints be excessively tender they may be protected by specially con- 
structed framework. The diet must be absolutely liquid, milk keep- 
ing a prominent place, to which may be added Vichy or seltzer 
waters. The free use of water is to be encouraged, as much as one 
gallon in the twenty-four hours being taken. With some persons 
this is difficult, but by flavoring it with orange, lemon, raspberry or 
other fruit juices, it is easily accomplished. If sweetening is de- 
manded, use saccharine, for all cane sugars and proteid food must 
be avoided. 

After many years' experience in the use of the various forms 
of salicylic acid, I have practically limited myself to the use of 
sodium salicylate, aspirin and salophen. These alone, or combined 
with small doses of strychnia, are prescribed in rapidly increasing 
doses until the physiological effect is obtained, and which, in my 
opinion, should be maintained until the subsidence of the disease. 
Salicylates act a great deal as quinine, and by some are considered 
an absolute specific. Heat is an essential method of treatment to 
obtain results in acute articular rheumatism. In private practice, 
where the practitioner has no access to special apparatus, we may 
employ the full dry pack. The night garment should be removed, 
the blankets warmed and the patient enveloped in them, where he is 
to remain until perspiration takes place. Where we have access to 
the incandescent light we may use the general application or local 
electric light bath applied to the inflamed joints. In sanatorium prac- 
tice there is nothing comparable to the use of superheated dry hot 
air at temperatures ranging from 200° to 325° F. for the entire body, 
or 300° to 400° F. for the local application to a single joint. These 
applications are all absolutely harmless, and fulfill the four indica- 
tions of combating the inflammation, increasing elimination, reliev- 
ing the pain and preventing complication. There is no question but 
what the very great cutaneous activity induced aids in the elimination 
of the lactic acid and other waste products found in the body. If 
at the same time the patient is drenched with water internally, we 
will find that during the application the perspiration is more profuse 
and elimination through the kidney better. With the dilating of 
the surface vessels and the profuse perspiration, heat elimination 
will be favored and temperature lowered. The action of heat, gen- 
eral and local raises the temperature of the blood one or two de- 
grees, and this seems to be the therapeutic factor. It has often 
seemed to me that it was a true bactericide. The heat certainly 
favors vascular activity, reduces the local congestion, stimulates 
metabolism, increases elimination, relieves pain and destroys those 



290 PRACTICAL HYDROTHERAPY. 

products that are likely to produce complications. It will be noticed 
by patients that the profuse diaphoresis is promoted without head- 
ache, but it is always advisable, in administering the above treat- 
ments, to place a cold cloth upon the patient's forehead, unless there 
is some rheumatic involvement of the scalp. After all treatments 
of this character, the patient must be removed and wrapped in 
blankets, where he is to remain for several hours. In the use of a local 
incandescent electric light bath in bed, whether it be general or local, the 
bed should be so prepared as to enable the nurse to immediately wrap 
the patient in blankets upon removing the apparatus, and thus prevent 
chilling. 

Where the general or local superheated dry hot air apparatus 
has been used, the patient should be placed in bed without re- 
moving the Turkish bath-robe, mittens or stockings in which he has 
been enveloped. As soon as perspiration ceases, the nurse carefully 
dries the patient with warm towels, avoiding exposure and chilling. 
Some cases are so sensitive that no attempt should be made to move 
them, because of the exquisite suffering that is caused by the slightest 
movement. When none of the above methods are accessible, we 
may place the patient in the hot full pack and at the same time apply 
very hot fomentations (160° F. ) to the joints. By exercising a 
little care the pack may be cautiously opened and Hie fomentation 
placed upon the joint. As soon as the tenderness in the joints sub- 
sides somewhat, we may apply a stimulating compress to them, wrung 
out of a saturated watery solution of common or sea salt at 60° F., 
and allow same to remain until dry. Some recommend the addi- 
tional use of oil silk or rubber tissue to prevent rapid evaporation. 
In an extended practice I have seen this treatment give immediate 
relief to pain that had been merely obtunded by opiates, which should 
never, if possible, be administered in these diseases. Prevention of 
complications is best met by the heating and sweating procedures 
above mentioned, as they promote the activity of the skin and kidney 
and at the same time eliminate the poison likely to injure heart o. 
brain. 

Hyperpyrexia, though a rare complication, may occasionally de- 
velop. If there is the slightest tendency toward an increased eleva- 
tion of temperature above 104.5° to 105° F., or the presence of any 
nervous symptoms, the cold cephalic compress should be applied to 
the head, or the cold cephalic coil or ice-cap may be used. If tli i - is 
not sufficient, apply the hot full pack until perspiration takes place, 
followed by the cold sponge, exposing only a portion of the body 
at a time. Should the temperature, however, continue to rise above 
104.5° F., we may have recourse to the full bath at 94° F., gradu- 
ally reduced to 80° F., using friction during its application, and keep- 
ing the ice-cap or coil upon the head. Xo medicines are of any value 



RHEUMATISM. 291 

in this condition, and the physician should never hesitate, but use 
the full bath at once if he desires to avoid fatal outcome. In this 
respect these cases resemble those of insolation. Where the pulse 
indicates cardiac weakness, or the ear detects threatened complication, 
it is well to apply the ice-bag to the precordia. I am satisfied that 
the more frequent use of the ice-bag would prevent these compli- 
cations. Sufferers from this disease are apt to be left in a most 
anemic condition, and in many instances I have seen disagreeable 
cases of neurasthenia develop, the treatment of which will be found 
in another section. 

Convalescence demands considerable care and thought. Moderate 
closes of the salicylates, combined with alkalies, should be continued, 
and at the same time tonics of iron, quinine, strychnine, glycero- 
phosphates, etc., administered. The rheumatic should be gradually 
and systematically trained until tonic hydriatic measures have been 
attained. From a practical experience of eighteen years, I feel 
satisfied that the frequent use of cold water will do more toward 
protecting these cases from relapse than any other known form of 
treatment. The tonic measures to be employed should commence 
with the dripping sheet at 90° F., the temperature gradually reduced 
until 70° F. is reached. At this time we may employ the superheated 
dry hot air, the incandescent electric light bath, dry hot air or vapor 
bath, followed by the rain bath at 102° F. for one and one-half min- 
utes, reduced to 65° F. for ten to fifteen seconds, to which may be 
later added douches, especially the Scottish douche, to those joints 
that have been affected, at 110° to 115° F. for twenty to thirty sec- 
onds, reduced to 60° F. for five to ten seconds, four or five alterna- 
tions. 

The cardiac complications are best met by the method known as 
the "Schott system," consisting of the artificial Nauheim baths and 
graduated exercises. 

Chronic Articular Rheumatism. 

Chronic articular rheumatism' is an afebrile chronic affection, 
characterized by stiff and painful joints. I mean a disease in which 
the capsule and ligaments of the joint and tendon sheaths adjacent 
to the affected articulation are thickened, and in which the principal 
and conspicuous symptoms are pain and stiffness in movement of 
the affected joint. These conditions are found mostly after the 
middle period of life, and in those who engage in the laborious hard- 
ships of manual labor, exposed to cold and dampness. They are 
the people who have creaking and cracking joints due to dryness 
and roughness of the articular surfaces. This disease is usually 
compatible with a fair degree of health, although I have seen many 
sad cases of extreme disturbance result from the affection. The mc- 



202 PRACTICAL HYDROTHERAPY. 

tality is practically nil, and the disease is usually resistant to ordinary 
remedial measures. It is in this field that hydrotherapy has made 
some of its most brilliant cures. Most of the patients are unable 
financially to remove to a climate free from cold and dampness, and 
for that reason demand treatment at home. They are not benefited 
by anti-rheumatic remedies or diet, but should be liberally fed on a 
diet, in my opinion, in which meat is not entirely excluded, but used 
in moderation. Fats must be liberally administered, and to this end 
butter, milk, sevetol, buttermilk, Russell's emulsion of mixed fats 
are valuable. Cereals, fruits, vegetables, moderate amounts of sweets 
and well-cooked bread should constitute the dietary. I rarely ever 
use anything else except tonics. Hydriatic measures offer an excel- 
lent means of combating the disease, and should have for their object 
the relief of the pain and the increasing of general vital resistance. 
Home treatment is often of great value. A hot full bath at night, 
followed by the full dry pack for one hour, will oftentimes mitigate 
the pain and secure restful sleep. Where this cannot be carried out 
— and this is frequently the case in private homes — fomentations may 
be applied to the affected joint. Where this is not accessible, the 
stimulating compress applied to the affected joint, covered with flan- 
nel and oil silk, is oftentimes productive of satisfactory results. Here 
again we may employ the compress dipped in a saturated watery solu- 
tion of common or sea salt, at a temperature of 65° F., allowing 
same to remain on all night. 

With institutional facilities nothing is comparable to the use ot 
superheated dry hot air. Where the condition affects a large number 
of joints it is best to use the full body apparatus, commencing with 
twenty minutes at 200° F., gradually increasing the time to one hour 
and the temperature to 300° and 350° F., being careful to keep the 
head cool by means of the turban, cold compress or ice-cap. Where 
a single joint or two are affected, the local or small joint apparatus 
should be used, and the temperature raised to 400° F., same dura- 
tion. The Turkish bath, Russian bath and hot vapor bath have all 
been found useful, but in my experience not so valuable as the first- 
named treatment. Many spas have won their reputation on the treat- 
ment of this affection by hot alkaline or other mineral waters, notable 
among which are the hot springs of Virginia and Arkansas, and 
Mount Clemens, Mich. In Europe, mud, sand, peat and mineral 
baths have been used, but none possess any therapeutic value because 
of the animal or mineral matter contained in the springs. Hydro 
therapy must be persistently and thoroughly applied if permanent 
results are desired. The final aim of this treatment, however, is to 
train the patient to stand tonic cold procedures, and as soon as the 
pain is partially relieved graduated cold bathing should be used. To 
this end we may start with the cold sponge, move to the dripping 






RHEUMATISM. 293 

sheet, and finally utilize the more active tonic measures of the rain 
bath and douches. The Scottish douche, in connection with super- 
heated dry hot air, has proven in my hands the most satisfactory of 
all methods. As soon as the pain begins to subside the patient should 
be trained to the Scottish douche and encouraged to bear the water 
very hot (115° F.) for twenty seconds, thirty pounds pressure, and 
cold (60° to 50° F.) for five seconds, if possible. This he will be 
able to do, as there are usually no cardiac complications to interfere. 
Never use cold immersion baths (full cold bath, half bath, etc.). 

For many years I have alternated this procedure with the use of 
massage, mechanical vibration and static electricity, giving vigorous 
massage of the muscular and joint structures, and applying heavy 
sparks to the affected areas, followed by the use of the static wave 
current to the affected joints. Exercise in the open air, especially 
in the sunlight, should be enjoined upon these cases. When recovered 
they should wear woolen underwear all the year round and avoid 
strains upon joint and muscular structures. 

Muscular Rheumatism. 

The so-called muscular rheumatism is, in my opinion, a myositis 
which may or may not be set up by the rheumatic toxin. It is an 
affection of the voluntary muscles, characterized by soreness or ten- 
derness to pressure over the affected muscle, stiffness and discom- 
fort or pain on movement. My experience has been that the major- 
ity of cases are brought on by exposure to cold, and occur in patients 
who are the subjects of gastro-intestinal intoxications. I consider the 
inflammation in its primary stage to be of an exudative and adhesive 
type, binding together, as it were, the muscular fibers or bundles ; 
later we have a proliferation of interstitial tissue, which results in 
an infiltration of the muscle and subsequent increase in hardness or 
density. The most frequent seat is that of the lumbar muscles (lum- 
bago), the intercostal muscles {pleurodynia), the deltoid and the 
sterno-mastoid muscle I torticollis, wryneck). Careful differential 
diagnosis should be made, for many cases diagnosed muscular rheu- 
matism or its subdivision are in reality neuritis, an affection of the 
vertebrae or some other condition that may occur in the locality af- 
fected. In the treatment of this affection superheated dry hot air 
has probably secured more rapid and brilliant results than any other 
measure, and its administration as described under "Chronic Artic- 
ular Rheumatism" is applicable here. Where we have a lumbago or 
pleurodynia to deal with, or even in cases of wryneck, we will again 
find that the Scottish douche is a method that nearly always insures 
prompt success. Where these methods are not accessible, however, 
the electric light bath to the affected part may be employed for the 
same purpose. If this cannot be obtained, the fomentation is the 



294 PRACTICAL HYDROTHERAPY. 

best method to use. The author has stopped the use of liniments 
and salves. 

I consider the after-treatment highly important. If the patient 
would maintain health he must keep his skin in healthy activity by 
daily bathing and the constant use of cold water. Where he has access 
to institutional treatment, the tonic measures suggested in "Chronic 
Articular Rheumatism" apply here, as do the applications of mas- 
sage and static electricity. Moderate exercise in the fresh air and 
generous diet, freedom from alcohol, wines or beer, the avoidance of 
tobacco, free water-drinking and tonic hydrotherapy are the pre- 
ventive measures that will insure good health. 

Rheumatoid Arthritis. 

Arthritis deformans is a chronic progressive and destructive dis- 
ease of the joints, characterized by deforming changes in the synovial 
membranes, cartilages and bones, with bony outgrowths which inter- 
fere to a greater or less extent with the mobility of the affected ar- 
ticulations. It occurs oftenest in women, and most frequently af- 
fects the hands, elbows, neck and knees. Its origin is not well known, 
though it is supposed to be a trophoneurosis, and we find it frequently 
brought about by worry, grief, mental shock, overwork and elements 
that influence the nervous system. In the majority of cases the 
progress of the disease is arrested, leaving several joints more or 
less crippled. A few become helpless and bed-ridden, but, as a rule, 
the milder forms of the disease are not incompatible with fair health 
and a long life. The treatment should be commenced early, with the 
object of arresting the disease and preventing destruction of the 
joints. To this end it is of importance to maintain the general health 
at its highest point, for it will be found that in proportion to general 
good health will the disease be slower in progress and prompter in 
arrest. In this disease the patient should be well fed, with a liberal 
dietary of meat, eggs, milk, butter, vegetables, and even malt liquors 
may be advantageously added. Fresh air and moderate exercise are 
useful adjuncts. 

The local treatment of the affected joints embraces the use of 
superheated dry hot air, local electric light bath, followed by the appli- 
cation of the Scottish douche at 115° F. for the hot and 70° F. for 
the cold, thirty and five seconds, respectively, three alternations. 
Where these treatments are not accessible we may employ the stim- 
ulating compress at 60°, wet in a saturated solution of common or 
sea salt, covered with a blanket or oil silk and allowed to remain 
on several hours, followed by movement of the joint and local mas- 
sage. My own preference is for superheated dry hot air, and it has 
yielded me some most excellent results where carefully and persist- 
ently applied. 



GOUT. 295 

General treatment may embrace the use of the body apparatus 
for superheated dry hot air for one-half to one hour, followed by the 
rain bath at 102° F. for one and one-half minutes, reduced to 65° 
F. for ten seconds, or the 'Scottish jet douche to the affected joints 
and spine for thirty seconds at 115° to 120° F., followed by a tem- 
perature of 60° F. for ten seconds, pressure twenty to thirty pounds. 
In the same manner we may employ the incandescent electric light 
bath instead of the superheated dry hot air. I have tried the Nau- 
heim bath for this condition, but have not found it very serviceable. 
Most patients do best in these conditions when sent to sanatoria. 
Dry hot air at a high temperature produces free perspiration and is 
well borne. The heart is unaffected, the swelling and stiffness of the 
joints combated, the pain relieved. 

As alternating treatment we may use massage, gymnastics and the 
static wave current. Give the massage first and follow this by static 
sparks to the spine and the sparks and wave current to the affected 
joints. I have tried the cataphoresis of mineral substances by the 
galvanic current to the joints, but have never seen the slightest ben- 
efit result. Tonics are always useful in these cases, and sometimes 
iodide of potassium. 

Some springs are valuable in this line — the hot springs of Arkan- 
sas and Virginia, Mount Clemens in Michigan, Richfield Springs of 
New York, Bath in England, Baden, Wiesbaden and Carlsbad in Ger- 
many. 

Gout. 

Podagra is a constitutional disease, usually the result of an in- 
herited fault of nutrition, characterized by acute attacks and a chronic 
state, with the presence of uric acid in the blood and deposits of urate 
of sodium in certain joint structures. My observation has been that 
fermentation in the intestinal tract precedes the acute attacks, and is 
present most of the time in the chronic form. This condition is 
usually aggravated by free indulgence in eating. Acute gout is rare 
in America, though the chronic form is fairly frequent. We prob- 
ably see more cases of "American" or irregular, commonly denomi- 
nated lithemia, in this country. Gout is compatible with longevity, 
although it may possibly shorten life by kidney involvement, fre- 
quently being the origin of interstitial nephritis. The essential ele- 
ments in the treatment and mangement of these cases, both acute 
and chronic, may be resolved into four distinct categories : ( 1 ) Control 
of dietary; (2) counteraction of auto-intoxication; (3) the favoring 
of elimination and oxidation of proteid waste material and toxins ; 
and (4) the gradual development of vital resisting capacity. 

The diet should consist of varied foods. A moderate amount 
of proteid food in the form of meat may be allowed once daily. 



s — ^ 



296 PRACTICAL HYDROTHERAPY. 

Those meats that are rich in nucleins, such as brain, liver, kidney, 
thymus, and which increase uric acid, should be eliminated from the 
diet. In this category fall rich sauces, pork, veal, salted and smoked 
meat or fish. One should gradually change from a rich meat diet to 
the gout one. Fats may be generously used, and in this line, milk, 
buttermilk, butter, cod-liver oil, sevetol and Russell's emulsion may 
be employed. Milk is of advantage, as it increases the excretion of 
xanthin bases and reduces that of uric acid. Cereals of all kinds 
may be used— oat meal, cracked wheat, "Force," etc.; fruits, both 
raw and cooked, with no sweetening — raspberries, blueberries, straw- 
berries, apples, oranges, etc. Fresh fish and eggs in moderation. 
Vegetables are excellent. Peas, string beans, corn, potatoes, turnips, 
carrots, parsnips, celery, cauliflower, artichokes, salads, cucumbers, 
egg plant; also bread, rice, sago and tapioca. Vegetables create hip- 
puric and benzoic acids, both of which are solvents of uric acid. 

The gouty must avoid alcohol, ales, beer, sweet and heavy wines, 
pastry, pies, pancakes, rhubarb, tomatoes, radishes, cabbage, sugars, 
sweetmeats, pickles, tea, coffee and tobacco. Water is to be freely 
drunk because of its diuretic effect and power to remove the 
alloxuric bases (uric acid, xanthin); by free use of water I mean 
the ingestion of at least one gallon per diem. The alkaline waters, 
especially Vichy, may be used instead of the ordinary plain pure 
water, but should be as freely drunk. The rule for the gouty is to 
eat slowly, masticate thoroughly. Simplicity should be observed at 
meals, thereby avoiding a large variety at one sitting. 

In the treatment of the acute attack all food should be immedi- 
ately shut off and a brisk calomel purge given, alkaline waters in- 
gested, and the wine of colchicum or some preparation containing 
colchicum administered. Two methods of local hydriatic treatment 
may be employed — hot or cold. The use of the local superheated dry 
hot air at a temperature of 400° F. for twenty minutes to one hour will 
do a great deal to relieve the pain and swelling of the joint. The 
local electric light bath may likewise be utilized for imparting heat 
to the affected part. If this is not attainable, a very hot fomentation 
at 160° F., covered with oil silk, will be found grateful. Some cases, 
however, prefer the application of the cold compress, repeated as 
frequently as it may become warm. In this we should be largely 
governed by the patient's feelings, and care must be taken not to 
overdo treatment during the acute attack. As soon ?s this subsides, 
institute the treatment below outlined. To counteract the auto-intox- 
ication of the chronic state we have recourse to the dietary above out- 
lined, to the increased ingestion of water and the employment of 
certain anti-fermentative medicines, the most satisfactory of which 
have been, in my hands, guaiacum, zinc or sodium Milpho-carbolate 



/*■" 



GOUT. 297 

and potasssium permanganate. The last preparation I have made 
with a coating soluble only in the intestinal secretion. 

To encourage tissue changes, elimination and the oxidation of 
toxins and proteid waste material, we must have recourse to the 
prolonged use of sweating measures, and to this end we may employ 
the full dry pack for one to one and one-half hours ; the full wet 
pack for the same length of time ; the vapor, Russian, Turkish, electric 
light, hot air bath or superheated dry hot air. After quite a little 
experience in the treatment of these conditions I have gradually 
narrowed the treatment to the following: The patient is placed in 
the superheated dry hot-air body apparatus, enveloped in Turkish 
toweling and bath-robe, and submitted to a temperature ranging 
from 250° to 350° F., and is allowed to remain therein from twenty 
minutes to one hour, the head being kept cool by a cold compress 
or an ice-cap. This treatment may be applied daily, or we may 
alternate with this and the local superheated dry hot-air apparatus 
applied to the joints affected, at a temperature from 350° to 400° F. 
for an hour. My experience in the use of this method has not been 
disappointing, and I have seen tophi and other solid manifestations 
of gout softened and eliminated. There is no question but what the 
raising of the blood a degree or two in temperature and increasing 
the circulation in the skin or in the part affected produce changes 
incapable of attainment by any medicinal measure. 

There is no question of a doubt concerning the efficacy of the 
stimulating compress applied at 60° F to the joints affected. The 
compress should be wrung out "wet," using a saturated watery solu- 
tion of common or sea salt, applied well covered with flannel, and 
finally oil silk or rubber tissue. It must remain upon the joint during 
the night. I have seen some good in subacute attacks from the 
primary application of heat — a hot foot- or hand-bath, fomentation 
or compress, followed by the above method of stimulating compress. 
We may in private homes follow another method : Give a very hot 
full bath for five or ten minutes, taking care to avoid catching cold, 
after which the compress is applied to the affected joints. This 
treatment is best given in acute cases, night and morning ; in chronic 
cases at bedtime. 

The aim after the above treatment should be to gradually train 
the patient to stand the tonic hydriatic measures of rain bath and 
douche, especially the Scottish douche, 115° F. for the hot, 60° F. 
for the cold Jhirty and five seconds respectively, four alternations. 
It has been my observation that by so treating these cases and 
gradually developing their vital and resisting power through the use 
of tonic cold methods we not alone preserve the health, but by keep- 
ing the system free from the causative factors prevent recurrence- 



•> 



298 PRACTICAL HYDROTHERAPY 

of acute attacks and the deforming and crippling effects of the 
chronic condition. 

From time to time gouty persons should subject themselves to 
courses of hydrotherapy as above outlined. This is best obtained 
in some institution or sanatorium, where it may be combined with 
applications of massage and static electricity. In my hands static 
sparks to the spine and over the affected joints, followed by the 
application of the static wave current to the affected parts, in con- 
junction with massage, hydrotherapy, diet, exercise, gymnastics, 
tonics and intestinal antiseptics, constitute the rational treatment. 

Where .we have to deal with retrocedent forms, if they be cerebral, 
cold should be applied to the head and the hot full bath adminis- 
tered ; if gastro-intestinal, the hot abdominal pack, the hot full bath 
or hot compress. 

Lithemia — Uric Acid Diathesis. 

Lithemia, irregular or anemic gout, uricemia, or the so-called 
"uric acid diathesis," is a condition in which the fluids of the body 
are surcharged with nitrogenized waste in the form of uric acid and 
other toxic bases, characterized by symptoms of gastro-intestinal 
indigestion and intoxication, by indefinite muscular and joint pains, 
and by a host of nervous symptoms and phenomena, all of which 
are usually associated with a high-colored, scanty r.rine, in which 
crystals of urates, uric acid and oxalates are present. The writer 
does not desire to enter here into a discussion of the relation between 
these symptoms and "uric acid," but simply believes that this is a 
state that has been in the past so denominated, but which in the 
future will probably be shown to be due to other toxic conditions 
than uric acid. Its origin is usually to be traced to an inherent ten- 
dency on the part of the tissue in many cases. In others "high" 
living, little physical exercise, and sedentary habits, together with 
the eating of large quantities of proteid material, produce the 
symptoms. These cases have always seemed to me to bear a close 
resemblance to a flue with an imperfect draught, and this is borne 
out by treatment which has for its object increased and more perfect 
oxidation of tissue. The affection is one in which there is too great 
input and too little output, for faulty elimination of waste products 
is followed by a most deleterious influence, especially venting its 
influence upon the nervous system. My observation has been that in 
these cases the sphygmomanometer will show a condition of hyper- 
tension in the arteries. The pulse is apt to be hard and the second 
aortic sound accentuated. Failure to remove the condition brings 
about chronic interstitial nephritis, arteriosclerosis and heart disease. 

The first indication for successful treatment is the regulation of 
the diet. Proteid food, especially those rich in nucleins (brain, liver, 



DIABETES. 299 

spleen, thymus, etc.) should be immediately cut out and ordinary 
meats allowed but once daily. By gradually cutting down the quantity 
they may be eliminated entirely from the bill of fare. Milk, cream, 
buttermilk, eggs, lettuce, spinach, celery, salads, and moderate use 
of starchy and saccharine foods, constitute the diet. Fruits are 
especially valuable, and should be eaten freely, both raw and cooked. 
The patient must not be allowed to drink tea, coffee, cocoa, or use 
liquors, wines, beers or tobacco. In these cases I have often found 
the use of fruit alone at one meal valuable as an antiseptic and 
eliminant. Exercise, fresh air and the free drinking of plain, alkaline 
and carbonated waters to the extent of one gallon per diem must be 
insisted upon. Digestive disturbances are to be corrected according 
to conditions found after a test meal ; constipation met by the use of 
the abdominal compress worn during the night or the sinusoidal 
current. Hydrotherapy will do more to cure these cases than any 
other method of which I know. We must increase the draught and 
burn up the waste material. For this purpose the full hot bath, 104° 
to 108° F., if possible ; the full wet pack at 65° F. for one hour ; the 
dry full pack for one hour; the vapor bath, hot-air bath, Turkish 
bath, Russian bath, electric light or superheated dry hot air may be 
employed. My preference is for the incandescent electric light bath 
administered until free perspiration takes place, followed by the hori- 
zontal rain bath at 102° F. for one to two minutes, reduced to 70° F. 
for one-fourth minute, thirty pounds pressure, reducing the tempera- 
ture one degree daily to 60° F. Later follow this by the jet douche 
to the spine and legs at 65° F. for one-fourth minute. 

No matter which method is employed, it should be followed by 
a tonic cold procedure of brief duration, commencing with a mild 
application such as the cold sponge rapidly administered and moving 
to the dripping sheet, rain bath and douche. The action of this 
method is to increase the alkalinity of the blood, powerfully stimulate 
oxidation, favor elimination and destruction of toxic material in the 
blood. This is materially aided by the internal use of water and the 
restricted diet. Care must be exercised not to overdo the treatment 
with these patients. In sanatoria we can advantageously combine 
with the hydrotherapy, massage, both manual and mechanical ; vibra- 
tion, faradic and static electricity. I have found medicines of little 
practical curative value in this trouble. The salicylates, colchicum 
and alkalies may be tried. 

Diabetes Mellitus. 

Diabetes mellitus is a chronic affection characterized by the con- 
stant presence of grape sugar in the urine and excessive urinary 
discharge, with progressive loss of flesh and strength. Most com- 
monly observed in males, its origin seems to rise from some peculiar 



300 PRACTICAL HYDROTHERAPY. 

disturbance of the nervous system, and possibly from the excessive 
use of farinaceous foods and malt liquors. The majority of cases 
ultimately prove fatal from gradual exhaustion or profuse blood 
poison, ending in diabetic coma. Amelioration of the symptoms 
occurs and the progress of the disease may be greatly retarded, life 
being prolonged for many years, although complete recovery rarely 
occurs. 

The treatment resolves itself into a regulation ot the diet, the 
establishment of hygienic laws, exercise and the use of hydrotherapy. 
The diet should contain a minimum quantity of starch and sugars, 
and yet be as rich as possible in fats. The absence of carbohydrates 
increases the tissue burning, especially that of the muscles ; reduces 
the disagreeable symptoms, and, to a certain extent, prevents com- 
plications. The diet found most satisfactory must be monotonous 
and consist of the muscular parts of the ox, calf, sheep, pig, deer, 
game, all to be eaten with their gravies ; also fish and sardines. 
German sausage, mackerel, smoked ox tongue, cream cheese, break- 
fast bacon, butter, salad with mayonnaise and cream furnish the 
largest quantity of the food. Among the vegetables, spinach, celery, 
lettuce, cabbage, tomatoes, asparagus, olives, cucumbers, sauerkraut, 
brussels sprouts, onions, water cresses, all kinds of nuts, apples, 
lemons, strawberries, etc., may be used. Van Noorden's and Crofton's 
diet tables will be found of great help in this disease. 

Diabetics may live a long time in comfort provided they will 
submit to the intelligent control of the physician. Even when they 
are doing well they should be submitted to courses of treatment three 
or four times a year, during which time they are subjected to a close 
restriction of diet and the use of the measures herein suggested. As 
long as possible the occupation should be continued. 

Exercise is of great advantage to the diabetic. It is best taken 
in the morning, and may consist of walking, hill-climbing, horseback- 
riding, rowing, bicycling or golfing; this latter, the writer believes, 
is the most satisfactory. Where the individual is incapable of mus- 
cular exercise much benefit can be obtained by the use of "resistive 
exercise" administered immediately after the various hydrotherapeu- 
tic methods to be hereinafter indicated. The author has found it very 
satisfactory to combine the use of massage and mechanical vibration 
with exercise, but this mu?t not be used as a substitute for exercises 
in the open air, as it has a tendency to destroy the patient's self-reliance 
and activity, a condition that is present and which must be combated. 
Hydrotherapy is one of the most satisfactory of measures that 
can be employed in these diseases, but as diabetics do not always 
stand hydrotherapy well, at the start they must be carefully studied 
and trained to treatment. Cold tonic hydriatic measures are the aim, 
the best results being obtained when the full effect of the douches 



DIABETES. 301 

are reached. The basis of all successes in the use of water with 
diabetics is the question of reaction, which must be carefully watched. 
I may say, in passing, that chemical and medicinal baths found at 
springs or medicated at home possess no value over the plain and 
simple bath. Baths containing peat, mud and other similar sub- 
stances are absolutely detrimental to the diabetic, and tend to produce 
irritation and inflammation of the skin, one of the dangers of the 
disease. The influence of the treatment when fully established is 
that of a tonic roborant. with an increase of the circulation and good 
feeling of the patient. This psychic effect, brought about by the 
thousands of sensory impressions travelling through the skin to the 
brain, is of great value in increasing "the fighting power" of the 
patient, and should not be forgotten. We can commence the treat- 
ment by the use of the hot pack until the skin is warm and the 
cutaneous blood-vessels dilated. This should be followed by a rapid 
cold sponge at a temperature of 60° F. As soon as the patient 
responds substitute for the cold sponge the wet sheet rub at 75° F., 
lowering the temperature two degrees until 60° F. is reached. Now 
institute the electric light bath, hot air or superheated dry hot air 
to the point of perspiration, then apply the circular rain bath at 
104° F. for two minutes, reduced to 90° F. for half minute; lower 
the temperature of the cold water until 60° F. is reached, increasing 
the pressure. By this time reaction will have been well established 
and we may proceed with the full treatment. The author prefers the 
electric light bath continued until the patient perspires ; he is then 
removed to the rain bath at 104° F. for two minutes, reduced to 90° 
F. for fifteen seconds ; this is followed by the jet douche to the spine 
and lower limbs and fan douche to the body at a temperature of 80° 
F. for one-half to one minute. These temperatures should all be 
gradually reduced one or two degrees daily until 60° F. or even 50° F. 
is reached. The pressure should range between fifteen pounds at the 
start to thirty at the termination. 

Crofton 1 called attention to the fact that the glycolytic or sugar- 
destroying ferment was increased by cold water applications, due 
doubtless to the increased leucocytosis that follows the bath, as these 
cellular bodies are carriers of the ferment ; in this way the sugar is 
more rapidly destroyed, sometimes as much as 50 per cent, in a few 
days. In addition, as we have heretofore shown in the earlier pages 
of this work, the alkalinity of the blood is increased as well as its 
oxidative power, hence a diminution of the usual acidosis and a de- 
struction of toxins usually present. There is no question but what 
this treatment is followed by an increased absorption of oxygen, 
better elimination of carbon dioxide, and as a result an increased ox- 
idation of sugar, due to better activity of the muscular structures 

1 Croftan, A. C. . Medicine, January, 1904. 



^ 



302 PRACTICAL HYDROTHERAPY 

through the use of the douche. The author, as above stated, in many 
cases prefers the use of resistive exercise immediately after the bath. 
Among the most distressing of all the symptoms from which the 
diabetic suffers is pruritus. The itching at times drives the patient 
to scratching the skin, as a result of which we often find infection, 
boils, acne, etc. It interferes with sleep and leaves the sufferer weak 
and exhausted. Nothing in my hands has given such satisfaction as 
the neutral bath applied at bedtime for one-half to one hour, relieving 
the itch and inducing sleep. The genitalia should be bathed carefully 
twice daily and dressed with zinc stearate. Some authors have found 
the carbon dioxide bath of benefit, but this has not been the writer's 
experience. During the interims of treatment swimming will be 
found an excellent measure, as it combines the thermic effect of the 
w : ater with exercise, especially one that increases respiratory action. 

Diabetes Insipidus. 

Polyuria is an affection characterized by the continued excessive 
secretion of a very large quantity of pale, watery urine, free from 
albumin and sugar. It has its origin must frequently in diseases of 
the nervous system, especially hysteria, injuries, tumors, etc., although 
malaria and syphilis may produce the condition. It seems to consist 
of a dilatation of the renal vessels, the result of improper innerva- 
tion. The quantity of urine passed is sometimes enormous, ranging 
from one to five gallons in the twenty- four hours. The author has 
seen two and one-half gallons passed in a case of fracture of the 
skull, which recovered. While the prognosis is rather unfavorable 
to a radical cure, the patient may be kept in excellent condition by 
avoiding intercurrent maladies. The best treatment for the trouble 
has been found to be a regulation of the diet, plenty of fresh air, the 
wearing of flannels and the application of the various measures sug- 
gested under the head of diabetes mellitus. This exception should, 
however, be made, that the temperature should not be given lower 
than 60° F I have seen good come from this character of treatment 
alone. Hydrotherapy is aided by the use of the bromides and ergrt. 

Obesity. 

Adipositas is a disease of nutrition, characterized by the deposi- 
tion of an excessive amount of fat in many parts of the body. The 
amount of fat in a healthy adult is about one-twentieth of the body 
weight, and the possession of a considerable amount of this tissue is 
a valuable asset in health. It represents a reserve capital to be drawn 
on in time of need, thus diminishing drain on tissue proteids. In 
many cases there is an hereditary tendency, this tendency probably 
being an abnormally low power of fatty oxidation. It is more' fre- 
quent in women, is found in those who over-eat and over-drink, and 



OBESITY. 303 

is usually accompanied by anemia. This anomaly is probably ex- 
plained by the diminished oxidizing power of the blood brought about 
by the loss of hemoglobin, which is the oxygen-carrier. Treatment 
has for its aim to check the formation of fat and rid the body of its 
accumulations. Cases may be roughly divided into two classes, those 
that exhibit no heart symptoms and those that have heart symptoms. 
The diet must be regulated, must be monotonous, the consumption of 
fluids fairly limited, alcohol, wines and beers forbidden. Cold water 
charged with carbonic acid gas, or plain water in which Vichy or 
Kissengen salts have been dissolved, may be given in limited amounts. 
The daily program of treatment that has been found satisfactory 
is that of V Hoesslin 3 : 6:30 a.m., cold sponge, walking or other ex- 
ercise for half or three-quarters of an hour ; 7 :30, breakfast, tea or 
coffee with cream, one slice brown bread, thickly spread with butter ; 
9:30, one egg or slice of fat bacon; 10 to 12:30, exercise; 12:30, lunch, 
bouillon and egg, fat meat with salad, an apple, brown bread and 
mineral water; 1:30 p.m., rest and then a cup of tea or coffee; 3:15 
to 6:15, e>ercise; 7:00, dinner of proteid food and green vegetables 
chiefly. Billiards or skittles may fill up the evening. The various 
dietaries suggested by Oertel, Ebstein and Anders 3 may be used to 
vary the plan of V. Hoesslin. Sleep during the daytime should be 
absolutely forbidden, the patient to go to bed at 11 p.m. and rise at 
6 a.m. during the summer and 7 a.m. during the winter, not more 
than six or seven hours of sleep for the adult and eight hours for the 
child. Exercise is of great value, and its use in the open air must 
be insisted on. This may consist of walking for half or three-quarters 
of an hour after each meal — that is to say, four or five times a day. 
The time spent in exercise should be short at first and gradually in- 
creased, likewise the gait changed from a quiet to a brisk movement. 
In this respect women are refractory patients. Gymnastics and out- 
of-door sports, if wisely regulated so that overstrain is not produced, 
will break the monotony of the treatment. Oertel believes in gradu- 
ated exercise up slight elevations and inclines, beginning with slight 
efforts and gradually increasing them. He has laid out at his sana- 
torium special walks with this in view, it playing an important part 
in his system of treatment. He believes that it directly and methodi- 
cally invigorates the heart muscle. In severe cases the exercise some- 
times cannot be taken. In these vigorous massage, or, what is better, 
mechanical massage and vibration, may be substituted until the pa- 
tient is able to exercise. Sir Andrew Clark and others have suggested 
the use of the stair in the treatment of obesity. The patient should 
start from the top of a tall building and descend the steps. Later 

2 V. Hoesslin: Edinburgh Medical Journal, 1899. 

3 Oerlel, El.stein, Anders, J. M.: "Sajous' Analytical Cyclopedia of Practical Medicine " 
Vol. Ill, p. 114, 1905. 



304 PRACTICAL HYDROTHERAPY. 

ascensions are made. Muscular activity must be extended over three 
or four hours daily. The reason for this is the muscles are better 
nourished and absorb more food supply in direct proportion to the 
length of time muscular action is continued. 

Hydrotherapy is of value in obesity, and should have for its aim 
moderately prolonged cold baths ; it is valuable per se and as an aid 
to all other measures. We may start with the wet sheet pack at 65° 
F., continued for one hour, followed by the half bath at 60° F. for 
three minutes. The writer prefers the use of the electric light bath, 
hot air or vapor bath, or superheated dry hot air, used until profuse 
perspiration takes place, followed by some cold tonic procedure. The 
preference should be given to the electric light bath continued for 
fifteen, twenty or even thirty minutes, or superheated dry hot air, 
general application for one hour, producing profuse perspiration, 
followed by a soap shampoo and half bath, temperature 70° F., for 
three minutes, followed by the jet douche at 65° F to the spine and 
all over each extremity, and a strong fan douche to the abdomen and 
chest, total duration one minute, temperature of the water to be grad- 
ually lowered to 50° F. and the force of the douche increased. These 
baths will be found invigorating, stimulating and oxidizing. The pa- 
tient should dress quickly and exercise for an hour in the fresh air. 

Swimming, where prolonged for one or two hours daily, combines 
two factors capable of fat destruction, viz., cold and exercise. Swim- 
ming is not, as a rule, hard upon fat people, whose bulk enables them 
to float easily in the water. Where this desideratum cannot be at- 
tained, the full bath at 102° F, in which the patient sits and makes 
movements, may be substituted, although it is nothing like as good. 
The water should be gradually reduced to 75° or 70° F. and the dura- 
tion range from fifteen to thirty minutes. If the patient begins to 
shiver and the hands and feet to get cold, the bath must be stopped. 
It is an excellent plan to finish the treatment with the shower or jet 
douche at 60° F. for fifteen to twenty seconds, applied to the spine, 
back, legs and arms. 

Hot applications for the reduction of flesh should never be too 
greatly prolonged, and are finished by a vigorous cold application. 
A short general cold application following an application of heat for 
the purpose of producing perspiration to reduce weight in obesity, 
has the effect of restoring and increasing the disposition for muscular 
effort, in addition to the tonic effect upon the general nervous sys- 
tem. This enables the patient to add to the spoliative effects of the 
hot bath the still more positive effects of prolonged muscular ex- 
ercise. 

In those cases in which the subjective signs of heart involvement, 
dyspnea and palpitation, are present, the graduated climbing or walk- 
ing of Oertel is of great benefit in conjunction with the use of the 



RACHITIS. 305 

Nauheim or Schott method of treating heart disease. These baths 
should be commenced at a temperature of 94° F. for five minutes 
and gradually increased in acid and alkali, in time and temperature, 
until 76° F. is reached, with twenty minutes' duration. 

In conjunction with the above treatment arsenic, strychnia and 
thyroid extract may be used. 

Rachitis. 

Rickets is a nutritional disease, occurring in early childhood, char- 
acterized by changes in the structure of the bones, with consequent 
deformity, muscular weakness and nervous symptoms. Its causation 
is unknown, but syphilis, foul air, unhygienic surroundings, damp- 
ness, poverty, all predispose. The negro is especially subject to the 
disease. In rickets all the tissues are diseased, though the bony tis- 
sues are particularly affected. The aim of treatment should be to 
at once get the child out of its surroundings and change its diet ; 
sunlight and fresh air, if possible, at the seashore or in the country. 
Denizens of the city and those too poor to send children away must 
keep them out in the air, upon the roofs, in the parks, or make daily 
excursions to suburban parts. The diet should be at once changed, 
and the nursling fed by means of pasteurized milk ; older children 
must be given much fats, butter, milk, cream, purees of vegetables, 
eggs, lentils, beans, brains, sweetbreads, oranges, lemons, grapes, etc. 
Phosphate of lime, syrup iodide of iron, lime water, etc., are indi- 
cated. 

Hydrotherapy is very useful. The best method is the daily use 
of the full warm bath at 98° to 100° F. for ten to twenty minutes, 
followed by a brief, brisk cold sponge. Commence the treatment by 
giving each morning (in a room of proper temperature) the full 
warm bath, the first day ten minutes, increasing each day two minutes 
until twenty minutes is reached. As soon as the bath is finished, rap- 
idly sponge the child. The first day the water should be 90° F., and 
each day the temperature is lowered one or two degrees until 70° 
F. is reached. The sponging must be general and very quickly per- 
formed. Manual massage is of unquestioned value, and used in con- 
nection with cocoanut oil will aid in increasing weight. Galvanism 
or the galvano-faradic current from nape to epigastrium, or the spinal 
form, one pole at the nape, the other upon the sacrum, may be em- 
ployed. Institutional methods embracing these three treatments daily 
make prompt showing in rachitic cases. 



N 



CHAPTER XV. 
DISEASES OF THE KIDNEY AND BLOOD. 

Renal Hyperemia. 

Congestion of the kidney consists of an increase in the amount 
of blood in the vessels of this organ, characterized by pain, frequent 
micturition, scanty, high-colored urine, containing albumin and some- 
times blood. It most frequently originates from cold and exposure, 
though it sometimes occurs where irritating substances are eliminated 
through the kidneys. Mechanical causes produce a passive hyper- 
emia, usually from obstructive conditions, originating in the heart, 
lung or liver. An endeavor should be made to treat the disease as 
soon as possible, and upon ascertaining the cause this must be re- 
moved and the patient at once put to bed upon a liquid diet, or, what 
is better, milk in very moderate quantities. A dose of calomel, fol- 
lowed by a saline, and bland alkaline drinks, should be administered. 
The author does not believe in copious water-drinking with the idea 
of promoting diuresis, believing that this can be best accomplished by 
the ice-bag or cold compress applied to the lower third of the sternum. 
Those methods that produce free and active perspiration, and by their 
action drive the blood to the surface of the body, should be at once 
employed to assist in relieving the internal visceral congestion. The 
writer's preference is decidedly for the use of the body apparatus, 
superheated dry hot air, and he believes that in these conditions of 
the kidney this produces quicker diaphoresis than almost any other 
form of treatment. The method that has given him the greatest sat- 
isfaction is the following: Superheated dry hot air for twenty, thirty 
or sixty minutes, according to the case, at temperatures ranging from 
200° to 300° F., followed by the dry blanket pack for twenty min- 
utes, during which time fomentations are applied over the kidneys. 
Where this method is not accessible we may employ the hot full bath 
for one-half hour, after which the patient should have light friction 
to further favor cutaneous congestion and elimination, followed by 
the fomentation over the kidney. In the same way as the superheated 
dry hot air we may employ the ordinary hot air bath, electric light 
bath and steam baths. In this condition the Turkish bath has proven 
of great benefit, acting in the same general way that other measures 
do that pioduce an increased skin circulation. Winternitz suggests 
the use of the cold sitz baths at 50° to 70° F. for two to five minutes, 
but the writer has never found them of much value. Prompt measures 
(306) 



DISEASES OF THE KIDNEY AND BLOOD. 307 

of the character indicated will oftentimes prevent a renal hyperemia 
becoming an acute nephritis, of which it may oftentimes be consid- 
ered to be the primary stage. Convalescence should be marked by 
a careful return to 1he diet suggested for chronic Bright's disease and 
the use of the different measures that are suggested under that 
heading. 

Acute Nephritis. 

Acute parenchymatous nephritis, or acute Bright's disease, is an 
acute inflammation of the epithelium of the uriniferous tubules, char- 
acterized by fever, scanty, high-colored urine, dropsy, acute uremia 
and more or less nervous symptoms. It occurs most frequently from 
exposure to cold, especially wet cold, though irritant drugs occasion- 
ally produce the disease. It is common in children following acute 
infectious diseases, especially the exanthemata. In the management 
of acute nephritis time is an essential factor, and the physician must 
move quickly in establishing those measures that will take the load 
off the kidney and prevent destructive changes. The patient should 
be placed absolutely at rest in a warm bed, be clothed in woolen 
underwear, and the room itself kept sufficiently warm to favor per- 
spiration. The diet must be liquid, and where the patient is able to 
withstand entire removal of food nothing should be given but plain 
water and hot lemonade. The author is not in favor of the drinking 
of large quantities of water in this disease, as harm is frequently 
done by so doing. He believes that very moderate use of water, 
preferably hot, sipped with a teaspoon, will go quite a long distance 
toward allaying thirst and overcoming nausea should it exist. The 
bowels should be moved by means of calomel and a saline, and kept 
active by the administration of a high hot saline enema at least 
twice daily. While it is our endeavor to produce prompt perspira- 
tion and maintain same, excessive diuresis should not be aimed at. 
Where the secretion is very scanty we may increase it by the use of 
the very hot fomentation over the kidney at 140° to 160° F. for 
twenty minutes every three hours, and by the application of the ice- 
bag over the lower third of the sternum. The writer believes that 
hydrotherapy is the most certain and valuable therapeutic weapon 
for the management of this disease. There is an intimate reciprocal 
action between the skin and kidney, for while diaphoresis stimulates 
this compensatory action of the skin it must not be forgotten that 
it is not clone for its eliminant action alone. Even under free 
action of the skin only a moderate degree of elimination takes place 
as compared with the kidney, but its influence is certainly beneficial 
and stimulates other organs that would otherwise refuse to act. 
Any number of methods are open to the practitioner. Where access 
cannot be had to hospital or sanatorial treatment, we may em- 



^v 



308 PRACTICAL HYDROTHERAPY. 

ploy the hot full bath at 100° to 110° F. for twenty to forty minutes. 
This is especially a valuable procedure with children when followed 
by the full dry pack for twenty to forty minutes. To both of these 
methods may be added gentle superficial friction in order to maintain 
active circulation in the skin. There is no fixed rule to guide one in 
the administration of these measures; some cases do well, some do 
not : it is largely a matter of careful trying. In sanatoria the hot air 
bath, electric light bath or superheated dry hot air are valuable. The 
author much prefers the latter, administering the general application 
in the body apparatus for twenty to sixty minutes at 200° to 300° 
F., followed by the hot blanket pack for thirty minutes, with the 
simultaneous use of the fomentation to the kidney. The action of 
these methods is to divert half or two-thirds of the blood in the body 
to the skin, acting in this respect like a great suction pump, relieving 
the internal congestion, together with the interference of function 
that results therefrom. There is danger from chilling, and too great 
care cannot be exercised in this regard, as chilling of the surface 
will undo all the benefit derived from the heating measures. Should 
cardiac weakness develop, the ice-bag over the heart for fifteen minutes 
every two hours may be employed. Cerebral symptoms are best met 
by the cold cephalic compress or coil-cap to the head. 

Chronic Nephritis; Chronic Parenchymatous and Chronic 
Interstitial Nephritis. 

Chronic parenchymatous nephritis is a chronic inflammation of the 
cortical tubular structure of the kidney, characterized by albuminous 
urine, dropsy and attacks of acute uremia. Chronic interstitial ne- 
phritis is a chronic inflammation of the interstitial connective tissue 
of the kidney, slow in progress, characterized by the passage of large 
quantities of pale urine of low specific gravity, albuminous; disorders 
of the gastro-intestinal and nervous systems. It is nearly always ac- 
companied by cardiac hypertrophy. Chronic nephritic changes are 
usually in their incipiency cardio-vascular, before the true kidney 
conditions commence to be present. These cardio-vascular conditions 
are accompanied by high blood-pressure, hypertension, as a result of 
which disturbances occur in those organs that are supplied by end- 
arteries, chief among which are the kidney, retina and brain. The 
most frequent influences that are said to produce the disease are ex- 
posure to cold, alcohol, hepatic disease, and certain nervous influences, 
especially worry, grief and anxiety. The writer is inclined to believe 
that the origin of chronic nephritis is most frequently to be found 
in those who are given to the habit of constantly over-eating, as a 
result of which their systems are continually saturated with toxins 
circulating in the blood. In such cases we find the metabolism of the 
body lessened and elimination bv every channel diminished. With the 



DISEASES OF THE KIDNEY AND BLOOD. 309 

digestive disturbance comes an hepatic torpor or inability to cope 
with the flood of poisons circulating through the liver; the liver cells 
become incapable of eliminating or destroying these toxins. The 
final result of all this is a state of malnutrition upon which is super- 
imposed nephritic and other constitutional conditions. The progno- 
sis as to a structural cure is, of course, unfavorable, but excellent re- 
sults may' be obtained and life preserved for many years by the insti- 
tution of proper treatment. It seems to the author that much of the 
gloomy prognosis would be abated provided the patients could always 
have access to an intelligent management of their cases, and were 
willing to patiently follow out the treatment. As ordinarily treated, 
it is a grave and serious disease ; under favorable treatment these pa- 
tients live many years of great comfort and usefulness. 

A quiet life, free from anxiety, worry and care, is to be sought, 
and, if possible, found — certainly a difficult matter. The out-of-door 
life in an equable and uniform climate is very desirable. How few 
can seek the magic and health-giving climates of Egypt, the Riviera, 
Pasadena, Cal., or Palm Beach ! The diet should be varied and liberal. 
It should be mixed, and our endeavor should be to feed the patient 
rather than run the risk of letting him become anemic. Carefully 
watch the digestive disorders, which can frequently be regulated by 
lavage and hydrotherapeutic treatment. We may allow a general 
mixed diet, from which tea, coffee, cocoa, alcohol, cabbage, rhubarb, 
cheese, lobster, fried and greasy foods have been removed. Meat 
should never be eaten in excess, and at best in moderation twice daily. 
Saundby truly remarks: "Eat sparingly of butcher's meat, avoid malt 
liquors, spirits and strong wines." In the author's opinion, Crofton 1 
is unquestionably correct in restricting the quantity of water to be 
drunk. From a no small experience I can confirm absolutely his 
observations along this line. Of the limited amount of water allowed 
we may permit the patient to use the ordinary diluent table waters. 
The clothing should be warm and arranged to meet the seasons so 
as to prevent chilling. Constipation must be systematically treated, 
and a regular movement from the bowels secured. Excesses of all 
kinds must be scrupulously avoided, especially sexual. Hydrotherapy 
is of great value, its aim and action being to relieve the diseased or- 
gan and place it at rest as nearly as possible, and by securing this 
functional rest we maintain the renal parenchyma in good condition. 
Moderate sweating and active skin action, favoring elimination and 
improving the nervous system, should be our aim ; too energetic sweat- 
ing is bad. In the parenchymatous variety sweating measures have 
in the author's hands given so much satisfaction that in his practice 
he has practically limited his treatment to their use as a hydrothera- 
peutic measure. Commence with the wet full pack at 90° for twenty 

1 Crofton, A. C: "Clinical Therapeutics," 1906. 



310 PRACTICAL HYDROTHERAPY. 

minutes. Increase the duration five minutes and decrease the tem- 
perature three degrees daily until 70° F. is reached. The duration at 
no time should exceed one hour. If the heart is accelerated and res- 
piratory action quick, we may apply an ice-bag to the heart over the 
pack. The action of the treatment is to lower blood pressure, besides 
influencing the patient in the manner outlined under the section in 
which this measure is treated. The other measure is superheated dry 
hot air, using the body apparatus at a temperature of 200° to 300° 
F. for twenty, forty or sixty minutes, keeping the head cool by means 
of an ice-bag, and in this case, as in the pack, applying the ice-bag to 
the heart if its action is much accelerated. Either of these measures 
should be followed by the horizontal or circular rain bath at 70° F. 
for one-fourth minute. Note should be taken that in this treatment 
no hot water is administered in the rain bath. 

In the cirrhotic form we may employ superheated dry hot air at 
200° to 300° F. for twenty to thirty minutes, or the electric light 
bath for five to ten minutes, followed by the dripping sheet at 70° 
for three minutes, accompanied by vigorous friction. As soon as 
the patient reacts well we may substitute for the dripping sheet 
the circular rain bath at 104° F. for one minute, reduced to 70° 
F. for one-half minute, twenty pounds pressure, increasing pressure 
one pound daily until thirty is reached. Note that the temperature is 
not reduced below 70° F. If the heart is perturbed the treatment may 
be followed by the use of the ice-bag to the precordium from fifteen 
minutes. Under this treatment it will be noticed that arterial tension 
is lessened, digestive disorders improved, bronchitis removed and the 
nervous system markedly toned. 

The Turkish bath is very frequently prescribed in these conditions, 
but it must be most carefully used and prescribed under the physi- 
cian's order. This bath is usually left to the unintelligent adminis- 
tration of bath boys who know nothing of pathologj, and for that 
reason cannot intelligently administer it. The carbon dioxide baths 
and graduated exercise, that constitute the Schott system of treating 
heart disease, are quite useful in these cases. Commence with 
Na 2 C0 3 , 100 grammes, and HC1 100 c.c, temperature 95°, duration 
five minutes. The aim is to lengthen the duration, lower the tem- 
perature and increase the C0 2 present. With this in view we increase 
the Na 2 C0 3 and HC1 100 grammes every other bath until 600 to 
800 is reached. Every other day increase the duration one minute 
until the patient remains in the bath twelve to fifteen minutes. Lower 
the temperature one degree every other day until 85° F. is reached, 
beyond which point it should not be lowered. The action of this 
bath is to dilate the peripheral vessels in the skin by the irritation 
that the gas produces ; to reduce blood pressure, lighten the work of 
the heart, preserve this organ and produce the stimulating and tonic 



/* 



DISEASES OE THE KIDNEY AND BLOOD. 311 

effects that follow in their wake. It has a beneficial influence also 
in removing dropsy if it exists. As an associative treatment the 
author has found massage and static electricity of considerable value. 
Some cases demand nitroglycerine, digitalis and Basham's mixture. 

Uremia. 

Uremic poisoning is a term applied to a group of nervous 
symptoms produced by the retention in the blood of excrementitious 
substances normally excreted by the kidney. The condition arises 
most frequently during acute and chronic nephritis, and is due to a 
failure on the part of the kidney to eliminate some or all of the 
poisonous elements that enter into the composition of the urine. Its 
import is grave, depending on the chronicity of the cause. The pro- 
dromal stage should be the signal for immediate attention. Withhold 
all food and move the bowels freely by catharsis. Immediate free 
perspiration should be secured, and to this end we have access to 
three procedures. Where the patient is confined to bed we may use 
the hot full dry pack or the hot-air bath administered in bed. Where 
the patient is up and able to have access to sanatorium treatment the 
superheated dry hot air applied to the entire body at a temperature 
from 200° to 300° F. for twenty to thirty minutes will be found 
most effective, and, in the author's opinion, the most certain measure 
against this condition. No matter what measure to secure perspiration 
is utilized, it should be followed by a very brief tonic cooling measure, 
taking care to avoid chilling. In bed-ridden cases use the sponge 
and in ambulatory cases the rain bath at 70° F. for one-fourth minute. 
These treatments may be applied once or twice daily, and between 
them the fomentation over the lumbar region at 140° F. for ten 
minutes and repeated every hour. The patient should be urged to 
drink freely of hot water, lavage of the stomach practiced and high 
enemata of hot saline administered at least twice dai'y. Where this 
does not seem to prove effective, resort should be had at once to 
hypodermccylsis, administering seven to ten ounces of hot saline. 
During the entire time that we are utilizing the above measures we 
should employ the precordial compress over which an ice-bag of 
sufficient size has been placed to embrace the heart and lower third 
of the sternum. The influence of this last application is to strengthen 
the heart action and by reflex influences stimulate the circulation, 
flush the kidney with arterial blood, favor abundant elimination of 
both water and toxins. The after-treatment is that of chronic ne- 
phritis. 

Nephroptosis — Floating Kidney. 

See "Splanchnoptosis." 



312 PRACTICAL HYDROTHERAPY. 

Renal Colic. 

Renal colic results from the passage, or attempted passage, of a 
calculus or gravel from the pelvis of the kidney through the ureter, 
and is characterized by agonizing pain in the back, retraction of the 
testes, vesical irritability with sudden termination of the pain. The 
calculi are formed by concentric lamination with some foreign body 
acting as a nucleus. The Roentgen ray is a fairly satisfactory aid 
in diagnosis. During the attack our immediate aim should be the 
complete relaxation of the patient and the relief of pain. This can 
best be accomplished by the drinking of very hot water, the use of 
the hot enema and the hot full bath as hot as it is possible for the 
patient to stand. Higher temperatures can be secured if cold is 
applied to the head and an ice-bag to the heart. An excellent method 
is to just submerge the body in the very hot water without the water 
touching the ice-bag upon the heart. After the removal of the 
patient to bed very hot fomentations at 140° F. may be applied to 
the lumbar region for ten minutes, repeated every thirty minutes as 
may be needed. Morphia is oftentimes necessary. Between the 
attacks treat the underlying condition, which is usually that of gout 
or lithemia. Care should be exercised to avoid overeating and the 
use of alcohol. Free drinking of water, the use of Vichy water and 
the citrate and carbonate of potassium are to be recommended. 
These cases are nearly always surgical in their aspect, and the treat- 
ment above outlined is temporizing only in its results. In any event, 
the surgeon should be consulted with regard to each case of this 
character. 

Anemia; Chlorosis. 

These are symptomatic disorders of the blood, characterized by 
a deficiency of some of its principal constituents, especially the red 
corpuscles and hemoglobin, which are gradually reduced. These are 
pale people, who are affected with many nervous symptoms, cardiac 
palpitation and bruits, and oftentimes menstrual disorders. They 
originate in those who have suffered great loss of blood, who are 
the subjects of overwork, anxiety and grief, who are housed and lack 
bodily exercise, who are compelled to remain in badly ventilated and 
overheated offices and schools. In young girls they frequently arise 
from an unequal development of various physiological functions. 
Many are the subjects of splanchnoptosis. In a somewhat extended 
experience it is my personal opinion that the greatest number of these 
cases originate in diseases of the digestive organs, generally accom- 
panied by a relaxation of muscular fiber. They fail to digest and 
assimilate, are the subjects of marked toxemia, of ptomaines and 
leucomaines arising from the digestive tract, as well as the retained 
waste products of tissue change. Such cases, as a rule, have suffered 



DISEASES OF THE KIDNEY AND BLOOD. 313 

from chronic constipation for years, paying little or no attention to 
the calls and necessities of nature. It is to this class that Sir Andrew 
Clark has given, in my opinion, the apt designation, "fecal anemias." 
Hydrotherapy is as nearly a panacea for the treatment of these cases 
as exists in medicine. When we stop, to reflect that this agent stimu- 
lates the nervous centers and gives to them increased tone, rouses 
the temporarily dormant vital powers, deepens the respiration, in- 
creases the absorption of oxygen and the elimination of carbon 
dioxide, stimulates the appetite and digestion, increases assimilation 
and absorption, overcomes digestive disorders, relieves constipation, 
improves and increases the blood and lymphatic circulations, betters 
muscular tone over the entire body, enhances tissue change and in- 
creases excretion, it is no wonder, then, that it soon overcomes anemia 
and chlorosis and restores the body to vibrant health and strength. 
We should first seek in the treatment of this disorder for causal 
factors. Fresh air is beneficial, and so is moderate exercise, but care 
should be taken to avoid overexertion in these cases, as they do not 
stand it well. Breathing exercises are of great value to these patients. 
Where the case is weak and bed-ridden we may commence with the 
full dry pack, followed by the cold sponge at 70° F., reduced two 
degrees daily until 50° F. is reached. This treatment is to be followed 
by general friction after the entire body has been carefully rubbed 
down. As soon as the strength and reaction are somewhat developed 
we may administer the dripping sheet at 70° F for three minutes 
with vigorous friction, having the patient stand in a very hot foot- 
bath. The best time for this is in the early morning, while the 
patient is warm in bed, the collection of heat upon the surface favoring 
reaction. When this point has been reached it will be found that the 
full wet pack at 65° F. for half to one hour, followed by the half 
bath at 70° F. for one minute, may be instituted. Decrease the 
temperature of the bath two degrees daily and lengthen the time a 
half minute until the temperature of 60° F. and duration of three 
minutes has been obtained. In ambulatory cases we may administer 
the electric light bath or hot-air bath until commencing perspiration. 
Follow this with the circular or horizontal rain bath at 102° F for 
one and a half minutes, pressure twenty pounds, dropping the tem- 
perature to 70° F. for fifteen seconds. Reduce temperature one de- 
gree daily to 60° F. and increase pressure one pound daily until 
thirty is registered. At this point we may place the patient upon full 
treatment, the following being the best, in the opinion of the author: 
Electric light bath until commencing perspiration, followed by the 
rain bath at 104° F. for one and one-half minutes, jet douche to the 
spine at 60° F. for one-fourth minute, fan douche at 60° F. to entire 
body, pressure twenty pounds, gradually increased to thirty. It is the 
author's opinion that the electric light bath is by far the most valuable 



^ 



314 PRACTICAL HYDROTHERAPY. 

of all heating procedures, not only acting as a stimulant per sc, but 
seeming to bring out more vigorous corpuscular response. Under 
its use the hemoglobin rapidly increases. It is a good plan, especially 
in toxic cases, to permit the patient to perspire freely every third 
day. 

Certain rules should govern the administration of hydrothera- 
peutic measures in these disorders, among which may be mentioned 
the avoidance of the reduction of body temperature and to exercise 
care to increase the heat upon the surface before applying any cold 
measure. YVe can obtain in anemics the best and most vigorous 
nervous stimulation by very brief cold applications under consider- 
able pressure, owing to the percutient stimulation. Many of these 
cases suffer from insomnia, and should this occur the neutral bath 
for thirty to sixty minutes, or the hot and cold sponge to the spine, 
will promptly relieve the condition. For the cardiac palpitation 
nothing equals the precordial compress and ice-bag. It goes without 
saying thai certain medicinal measures should accompany the admin- 
istration of hydrotherapy, the author expressing a preference for 
Ehud's mass in large doses and the various forms of arsenic, es- 
pecially the acid and Fowler's solution. 

Pernicious Anemia; Splenic Anemia; Leukocythemia; Hodgkins' 

Disease. 

Pernicious anemia is a progressive form which tends toward a 
fatal issue. Its treatment and management is the type of method to 
be pursued with the other forms enumerated above. Their cause is 
unknown, but it follows pregnancy and lactation with great frequency, 
and is usually supposed to be due to a breaking down of the cor- 
puscles or some defect of hemogenesis, possibly brought about through 
some intestinal toxin or micro-organism. There are a certain number 
of cases that are curable, and in these arsenic is the remedy — Fowler's 
solution, from three to forty minims per diem. Hydrotherapy can 
materially aid in improving the general nutrition and enhancing the 
effect of the arsenic. We should at once correct any gastric trouble 
present, and, if necessary, use lavage, being careful to do so in the 
morning before breakfast, so as to rob the patient of no nutriment. 
Intestinal antisepsis is an important indication, and to secure this, 
thymol has been found to be the best in these cases. The writer has 
also used permanganate of potassium covered with a coating insoluble 
in the gastric juices. The diet should be simple, plain, concentrated 
and nutritious, at times predigested. Free water-drinking, high 
enemata and hypodermoclysis of normal saline solution have all been 
found useful. For the improvement of appetite we may employ the 
ice-bag over the stomach for thirty minutes before meals. The 
general application found most satisfactory has been the electric light 



DISEASES OF THE KIDNEY AND BLOOD. 315 

for three to five minutes, or until perspiration commences, followed 
by the rain bath at 100° F. for one and one-half minutes, reduced 
to 70° F. for one-half minute. Reduce the temperature one degree 
daily until 60° F. is reached and maintain the pressure uniformly at 
twenty pounds. These cases do not stand strong douches or much 
cold, and are cases that must be closely watched and reaction secured. 
The baths, as a rule, should be given every other day until the patient 
begins to improve, when they may be administered every day. 



CHAPTER XVI. 
DISEASES OF THE HEART AND BLOOD-VESSELS. 

Pericarditis; Endocarditis; Myocarditis. 

Pericarditis is an inflammation of the serous covering of the peri- 
cardium of the heart. It may be primary or secondary, acute or 
chronic. In some cases it runs its course unsuspected, at times is 
difficult of diagnosis, at other times self-evident. It is especially 
prone to occur during rheumatic attacks, the heart sounds appearing 
near the ear and limited in number. The disease of itself calls for 
and demands absolute bodily rest in bed, with freedom from worry 
and excitement ; laxatives, especially salines, should be administered. 
The diet must be concentrated, nutritious, liquid. The ice-bag applied 
over a precordial compress acts as a powerful antiphlogistic, quieting 
cardiac action and mitigating the severity of the pain. There is no 
danger in the proper use of the ice-bag, and it may be continued for 
weeks without any injurious or unpleasant secondary effects. From 
time to time it should be removed and the precordium rubbed with a 
dry crash towel. The ice-bag can be alternated with the precordial 
compress at 60° F. In the chronic stage of the trouble we may have 
recourse to the full wet pack at 60° to 65° F. for a half to one hour, 
care being taken to place the ice-bag over the heart during the admin- 
istration of the pack. 

Endocarditis is an inflammation of the membrane lining the 
cavities of the heart, accompanied by pain, precordial distress and 
disturbed cardiac action. This inflammation influences mostly the 
valves of the heart, producing a systolic apical murmur. It is often 
the origin of emboli, and the harm that it does is usually to lay the 
foundation for ultimate failure of integrity of the valvular structures 
or cause serious embolic attacks, the worst of which are those in the 
cerebrum. It is usually secondary to some other disease, especially 
the infectious fevers, rheumatism, etc. Bacteria are usually found 
in the lesions. Slight cases recover without much damage, malignant 
ones die. The aim should be in therapeutics to quiet the heart and 
conserve its tissue as much as possible. To do this absolute bodily 
rest is essential, care being taken to not even lift the patient up in bed. 
The diet must be liquid, easily digested, mostly milk. In this disease 
the ice-bag or cold compress at 60° F. must be kept constantly to the 
heart, although it is an excellent plan to remove the ice-bag every half 
to one hour and apply friction to the precordium. There is no danger 
in the ice-bag, which mav remain on for days, having been found to 
(316) 



DISEASES OE HEART AND BLOOD-VESSELS. 317 

calm the patient, relieve the dyspnea and oppression. No other hydro- 
therapeutic treatment during the acute stage should be instituted. 

Chronic endocarditis, usually a sequel of the acute form, may 
develop, however, in a healthy valve, being caused by habitual mus- 
cular overexertion, gout, alcohol, etc. The valves become deformed 
and thickened. The patient in the chronic stage must be gradually 
trained to hydriatic measures. Place the case in a full dry pack, 
followed by the cold sponge at 70° F., applied only to the upper and 
lower extremities for the first two days ; this in turn to be succeeded 
by the ice-bag to the heart for one or two hours. The next two days 
we may administer the cold sponge to the entire body, and as soon as 
the patient responds well to this treatment we may then apply the 
dripping sheet at 70° F. for one minute with vigorous friction, followed 
by the ice-bag to the heart for one hour ; increase the duration half a 
minute until the maximum period of three minutes is leached; reduce 
the temperature one degree daily until 65° F. is reached. In con- 
nection with the dripping sheet, general massage will be found to be 
of great benefit. At this stage the Schott exercises may be commenced 
and the patient gradually advanced along this line. 

In myocarditis caution must be used in the application of the ice- 
bag and high altitudes avoided. The same cautions with reference to 
the use of the carbon dioxide baths and Schott exercises in arterio- 
sclerosis apply with equal force to myocardial inflammations. 

Treatment of Chronic Organic Disease of the Heart and Blood 

Vessels. 

There are certain general rules and laws applicable to all forms 
of diseases of the heart and blood-vessels, and in order to avoid useless 
repetition the author will first lay down these general principles and 
rules for the guidance of patients, will enumerate the various methods 
of therapeutics, their uses and advantages, and will then consider the 
special diseases in which they are applicable. Many cases will be 
found in which one, two or even more lesions are present at the same 
time, and it is here that the practitioner who follows this line of ther- 
apeutics will have to use his sound judgment based upon the well- 
known principles of this therapy. Prescribing for cardiac cases 
requires us to mix some brains with the prescription if success is 
desired, and as this field is by far the most promising and certain 
of all methods known at the present day for the purpose of relieving 
these diseases, it behooves the student and physician to carefully study 
and consider the methods to be employed. Schott 1 very clearly stated 

1 Schott, Theo. : "The Treatment of Chronic Diseases of the Heart by Means of Baths 
and Gymnastics," London Lancet, Vol. I, p. 1143, 1891; "The Mineral Waters of Nauheim, 
Their Uses and Effects," 1894; "Balneo-Therapeutics and Mechano-Therapeutics Applied to 
the Treatment of Chronic Heart Disease," New York Medical Record, 1891; "Chronic Dis- 
eases of the Heart," New York Medical Record, June 29, 1901. 



318 PRACTICAL HYDROTHERAPY. 

that benefit may be expected to accrue in all cases of chronic heart 
disease, whether of valvular or parietal incidence, except where the 
myocardium has reached an advanced stage of degeneration or the 
vessels are the seat of aneurisms or far-advanced arterial sclerosis. 
It becomes a matter of indifference whether the incompetency depends 
upon valve lesions, muscle disease, or is the result of general dis- 
turbances of nutrition or disease of the vessels, thus making it suitable 
for all forms of chronic heart disease, neuroses of the heart, Graves' 
disease, etc. The rule to govern prognosis is that the cardiac muscle 
must be capable of response to the stimulus of the baths and exer- 
cises in order to be able to undergo compensatory hypertrophy. 

Such a broad statement can only be appreciated when one knows 
the intellectual and scientific calibre of the man making the statement. 
In order to successfully achieve results the physician must be in a 
position to devote a great deal of time to his patients, and they in 
turn must methodically and intelligently obey his instructions to the 
letter, taking sufficient interest in the "cure" to secure satisfactory 
results. 

In the early stages of the disease the physician himself must 
superintend the administration of the baths, the rest between them, 
and should himself first administer the resistive exercises, for he alone 
can in bad cases judge of the time required between the exercises for 
rest. 

There are three aims in the treatment of cardiac disease: (1) 
Reduce the abnormal systemic resistance to the column of blood in 
the general vascular system; (2) sustain perfect functional cardiac 
activity for such a length of time as to produce (3) compensatory 
hypertrophy. It should be remembered in considering the first aim 
we have in view that the capillaries of the human body are the masters 
of the circulation, and it is to these that we must look for the relief 
of the abnormal systemic resistance, for it may be stated that the 
greater the resistance of the arterial system the greater the strain 
upon the heart ; overcome this, and we are less likely to have dilata- 
tion. Where we secure active dilatation of the peripheral blood- 
vessels we "lift the load" from the laboring heart, the vis a fronte is 
improved, the vis a tcrgo strengthened through the thermic irritation 
that acts upon the vascular network of the skin. This is best accom- 
plished by general measures, as these stimulate the respiration, increase 
oxygen absorption and CO = excretion. As the respiration is increased 
it sucks the blood like a great pump into the lung tissue, relieving the 
right heart, preventing venous stasis and returning the re-oxygenated 
and rejuvenated blood to the left heart. It increases the general 
muscular and nervous susceptibility, relieves toxemia and improves 
the genera! well-being. Alcohol, digitalis and other cardiac stimulants 
do not have to be dispensed with during the use of hydrotherapy in 



s~ 



DISEASES OF HEART AND BLOOD-VESSELS. 319 

the treatment of cardiac disease, but where they are demanded smaller 
and more infrequent doses have to be used, as the treatment seems to 
develop an increased susceptibility to the action of these drugs. 

Hoffmann 2 says that much can be learned from a comparison of 
heart sounds. Little can be expected of digitalis when the second 
sound is weaker at the base than the first sound. This state of affairs 
he calls the "cold-water heart," and needs no medicinal management. 
In these cases the precordial compress and ice-bag and the full cardiac 
method of Schott are very useful. Deep breathing is of especial 
assistance. 

In this connection it may not be amiss to say that alcohol dimin- 
ishes the work of the heart, but also lessens its working power; 
digitalis increases the working power, but increases the work to be 
accomplished by the heart by increasing peripheral resistance. Both 
are toxic substances and add to the toxemia present. Cold applica- 
tions, on the contrary, increase the working power of the heart, 
diminish the work to be done, eliminate and destroy toxins, and, 
no matter how long used or how protracted, do not diminish cardiac 
susceptibility. Even where drugs fail the heart will oftentimes give 
prompt response to hydriatic measures, and where we find that the 
heart fails to respond to cardiac stimulants and yet responds to hydro- 
therapy, then a favorable prognosis as to the continuance of life and 
to improvement, even though temporary, may be given, though the 
results are more often permanent. Local cold stimulates the heart 
muscle and strengthens its contractions, and this continues for a long 
time after removal of the application itself. Local applications may 
be used to supplement the invigorating action of general measures. 
Carbon dioxide baths increase the vascular capacity by dilating the 
arterioles, lessening the heart's work by diminishing the peripheral 
resistance, the pulse becoming slower after the baths and exercises 
than before them, the arteries fuller. The dilated heart shows a 
smaller area by percussion due to diminished amount of blood in the 
heart chambers and to the better cardiac contraction. As the baths 
are repeated the speed of the heart in the interim progressively 
diminishes until a normal rate is reached. They should always be 
succeeded by a rest of one or two hours. Their action is to lessen 
the frequency of cardiac contraction, increase diastole, shorten and 
improve systole and thus bring about better cardiac nutrition. 

The general law may be stated that hot baths weaken the heart, 
cold baths strengthen. Where it becomes necessary, then, to use 
sweating measures and cardiac complications contraindicate their use, 
we may employ the electric light bath or superheated dry hot air in 
the reclining position with ice-bag to the heart, or the heating pro- 
cedures to the lower limbs alone. General cold friction is one of the 

2 Berliner klin. Wochenschrift, No. 14. 



— ' 



320 PRACTICAL HYDROTHERAPY. 

best measures for cardiac stimulation, as complete general reaction 
is secured without the displacement of blood to the interior. 

Summing up the advantages of hydrotherapy, we may say that it 
invigorates the heart's action, enlarges the volume of the pulse, better 
fills the arteries, lessens irregular heart action, reduces the resistance 
in the general arterial system, deepens respiration, favors the absorp- 
tion of any exudates that may exist, and gives to the heart increased 
power with diminished work. The author has found in treating this 
class of cases that it is oftentimes best to commence the course with 
the use of massage one day, the baths the next, and at the end of two 
weeks' treatment commence with the resistive exercises. These baths 
must be applied with some system and with a view to the condition 
of the patient, it being well to commence with a small amount of 
saline and gradually increase. 

In administering the exercises more care and attention is, in the 
author's opinion, required for success than in the administration of 
the baths. Exercises of any kind are contraindicated in the early 
stages of valvular disease, and should never be administered, as at 
this time absolute rest is indicated. When this state has passed the 
question of their use arises. They are indicated up to the time com- 
pensation is established, but exercise should not at this period be 
discontinued. To put it more clearly, Schott's system is to be pursued 
under strict medical supervision, together with the carbon dioxide 
baths, until compensation takes place, to be followed by a gradual 
system of after-treatment of moderate exercise, preferably hill- 
climbing, using the system laid down by Prof. Oertel, the changes 
and gradations being governed by the medical attendant. Compen- 
sation once established, exercise must still be taken, although strain 
or sudden violent exertion is to be avoided. Heart cases, as a rule, 
take too little exercise, and they should be stimulated in this regard. 
Active, strenuous and restless patients must be watched and guided, 
while the sluggish, timid and fearful ones must be urged to strive 
more actively. The patient should know his trouble in the right way, 
for he holds the renilt in his own hands. From the date of recovery 
he will have to adjust his mode of life to his condition, and this 
will require an intelligent conception of his own case. It is a good 
plan for such patients to keep themselves under restraint until the 
restraint becomes a habit; they should be deliberate in movements, 
avoid dancing, running for cars and muscular strains, keep all their 
passions under perfect control, mentally as well as bodily. The best 
forms of exercise are those that are taken in the open air, but if this 
cannot be obtained exercise should be taken when and where it 
can. For middle-aged and elderly people, riding and golf are the best 
forms ; for the young and vigorous we may allow them within limits 
to ride the bicycle, swim, play tennis and baseball. Breathlessness 



/? 



DISEASES OF HEART AND BLOOD-VESSELS. 321 

and palpitation are the danger-signals all must watch. Cheerful 
surroundings, pleasant company, the gentle intellectual stimulus of 
pleasant conversation, entertaining reading and good music are found 
to be beneficial to these cases. Their clothing must be adopted to 
suit the season, and where financially able they should, in winter, 
seek the balmy air of Florida or lower California, and in summer the 
cool and stimulating breezes of Michigan and Maine in this country. 
There are certain measures that are dangerous to those suffering from 
organic heart disease and should never be employed. 

The baths that are contraindicated are the full cold bath, cold 
jet, hot-air bath, superheated dry hot air, Turkish bath, Russian bath, 
full hot bath, or prolonged baths of any kind. It must be borne in 
mind, however, that the electric light bath and superheated dry hot 
air may be at times administered with the use of the ice-bag to the 
precordium. 

Schott Resistive Gymnastics. 

The movements are all gentle, "resistive" gymnastics, the slight re- 
sisting force employed being supplied either by the attendant or by 
the patient's own muscles. The former is the better plan. In the 
latter method the patient makes a gradual effort of contraction of 
certain sets of muscles, at the same time resisting the contraction with 
the opposing groups of muscles, this increasing the work done. For 
example, instead of freely and slowly flexing the arm, the extensor 
groups are called into action to resist the flexors to the needed extent. 
This should only be permitted in patients of intelligence and quick 
apprehension, and not in them until the ordinary resistance by a phy- 
sician or an attendant has been used often enough to demonstrate 
to them how the work is done and what amount of resistance should 
be offered. To use "self-resistance" properly requires a little practice 
to acquire control of the separate muscle-groups. The exercises be- 
gin with simple movements, and are so arranged as to bring into service 
in succession nearly every group of muscles in the whole organism. 
The movements are made very slowly, with a steady uniform motion, 
and with a short interval of rest (fifteen to thirty seconds) after 
each; no movement is repeated twice in succession. If there is the 
slightest sign of dyspnea or increased speed of breathing or pulse 
the least tendency to cyanosis, sweating or palpitation, the movements 
should be stopped at once, and if relief is not experienced the patient 
must lie down for a few minutes. The clothing should be loose 
everywhere, that there may be no interference with the peripheral 
circulation. 

The patient must not be allowed to think that the exercises are 
intended to effect any muscular development. In weak persons some 
gain in this direction may incidentally be made, but the object in 



322 PRACTICAL HYDROTHERAPY 

view is to produce certain results upon the heart and blood-vessels, 
and this should be brought about with an almost inappreciable amount 
of muscular exertion, certainly without enough to fatigue. 

The patient may either sit or stand during the exercise, according 
to his strength, but some of the movements, it will be seen, must be 
performed standing. The person in charge stands facing the patient 
or beside him, as may be needed, and makes gentle resistance to each 
movement. It is important that the attendant's resisting force should 
be used in such a manner as not to impede the circulation in any of 
the vessels ; the hand should either be applied to the part pressed upon 
with purely flat pressure, or, if it be necessary to grasp a limb, this 
should be done with a light, not a close, grasp ; the member should 
not be encircled by the hold. When the movements are for any 
reason intermitted, there must be no sudden change, and the patient's 
limb must be supported by the attendant in its return to an easy po- 
sition. 

The movements are as follows : 

1. The patient, standing or sitting, extends the arms forward 
level with the shoulders, palms together, hands held slightly open. 
The attendant puts his open hands on the dorsal aspect of the patient's 
wrists and makes light pressure, while the patient slowly separates 
the arms until they are in transverse line with the shoulders. The 
attendant then shifts his hands to the palmar aspect of the patient's 
wrists and makes light resistance while the arms are returned to the 
original forward-extended position. 

2. With the hand hanging by the side, the attendant supports the 
arm above the elbow with one hand. The patient flexes the forearm 
without moving the upper arm, until the thumb touches the shoulder, 
the operator's other hand resisting with pressure against the flexor 
surface of the wrist. The reverse movement of extension of the 
forearm is similarly resisted with pressure against the dorsal aspect 
of the wrist, the upper arm all the while steadied by the attendant's 
gentle grasp. 

3. The arms hanging, palms forward, are abducted and elevated 
until the thumbs touch above the head, the attendant making resistance 
upon the radial aspect of the wrists ; the arms are then returned to 
the original position, with resistance to the ulnar side of the wrists. 

4. The hands, with the fingers intertwined, palms toward the body, 
are held at the level of the abdomen and then raised until they are 
above the head, resistance being made to the radial aspects of the 
wrists. In the return the attendant receives the wrists in the fork 
between the thumb and forefinger, with the backs of his hands toward 
the patient. 

5. The hands hang by the sides, thumbs forward, palms against 
the thighs They are raised forward and upward with the arms 



DISEASES OF HEART AND BLOOD-VESSELS. 323 

straight and parallel until they are extended above the head. The 
motion is then reversed. The attendant's hands must make sev- 
eral changes of position to keep up a steady resistance during this 
movement, his fingers at first merely pressing the radial surface of 
the patient's wrist, then, as the arms are raised, lightly clasping the 
wrist with his fingers. During the downward movement the wrists 
are first received as in 4, in the fork of the hand ; then, when the 
patient's arms are level with the shoulders, the ulnar aspect of the 
patient's hand and wrist should rest upon the forefingers and thumb 
of the attendant, and, finally, the downward motion is resisted by 
the fingers of the attendant gently clasping the ulnar aspect of the 
patient's wrists. The resistance to this movement, Dr. Bezly Thorne 
says, "is the operator's pons asinorum, but it should be mastered.'' 

6. The body is bent forward from the waist and then straightened 
up ; resistance to the bending is made with a hand on the upper ster- 
num and to the recovery of the erect posture by a haud on the upper 
dorsal spine, the attendant standing beside the patient. 

7. The body is rotated from the waist, without moving the hips 
or feet, first to one side and then to the other, then returning to the 
original position. To resist this, one hand is applied flat upon the 
advancing shoulder over the claviculo-humeral junction, the other 
clasped over the shoulder which is being drawn back. The attendant 
will find it necessary to move one or two steps sidewise to maintain 
his relation to the patient. 

8. The trunk is bent sidewise as far as possible without moving 
the feet, to the right, to the left, and to the erect position again. The 
attendant resists with a hand in the axilla of the downward-moving 
side, his other hand pressing firmly on the opposite hip. 

9. This is a repetition of 2, namely, flexion of the forearm only, 
but in this movement with the addition that the hand is firmly clenched 
during the motion. First one arm and then the other performs the 
exercise. 

10. This is like 9, but with the palm turned outward. The arms 
act singly in succession. Resistance is made as in 2 and 9. 

11. The arm starts from the hanging position, thumb to the front, 
palm to the side, and moves forward and up to the vertical position. 
The hand is then turned palm down, and the arm lowered to the side. 
The attendant resists with one hand clasped about the wrist, substi- 
tuting the upward pressure of his free hand during the descent of 
the patient's arm from the vertical position. 

12. The arms are extended backward from the hanging position, 
parallel, as far as possible without throwing the body forward, and 
returned. Resistance is made with open-hand pressure during the 
backward movement, with a light clasp of the wrists during the re- 
turn. 



324 PRACTICAL HYDROTHERAPY. 

13. Standing by a table or chair, upon which a steadying hand 
may rest, the patient flexes the thigh on the trunk, and returns the 
limb to its original position. The movement is then repeated with the 
ether leg. The flexion is resisted by a hand upon the lower third of 
the thigh, and the return by a hand under the same part. Only the 
thigh muscles should be brought into play in this exercise, the leg 
hanging loosely from the knee. 

14. From the same position as in 13 the whole leg is extended 
forward and upward and then backward. The resistance should be 
applied above the ankle. 

15. From the same position as in 13 and 14; or. supported, if un- 
steady, by both hands on a chair, the patient bends the lower leg on 
the ihigh and returns it. Resistance is applied above the heel to the 
upward motion, in front of the ankle to the downward motion. 

16. Same position as in 13. The patient makes a lateral outward 
movement of the whole leg to the limit of motion, and reverses it. 
Resistance is applied at the ankle. 

17. The arms, extended sidewise level with the shoulders, are 
rotated from the shoulder-joint. The attendant resists by lightly 
grasping the wrist. 

18. Flexion and extension of the hand are made on the forearm, 
returning to a right line with the arm. The attendant supports the 
arm at the wrist, and resists the movements by pressure on the dorsal 
or -palmar surface of the hand, according to the motion. 

Similar flexion and extension of the foot on the leg, with appro- 
priate resistance on the dorsal and plantar surfaces, conclude the 
series. 

Schott sums up tersely the principles involved as follows: "Unsys- 
tematic exercise constitutes a heart-weakening ; systematic exercises, 
on the contrary, a heart-strengthening treatment. " 

Oertel's System. 

Professor O. Oertel, of Munich, published in 1885 an elaborate 
original system of treatment for "circulatory disturbances, enfeeble- 
ment of the heart muscle, incomplete compensation in valvular lesions, 
fatty heart, obesity and changes in the pulmonary circulation," founded 
upon ten years' observation of its usefulness. 

"The important phenomena ( observed in disturbances of the cir- 
culation ) are purely physical. It is therefore possible to expect to 
re-establish the hydrostatic equilibrium by mechanical means and by 
reducing the fluids of the organism. Afterward, or at the same time, 
consideration can be given to the causes of the circulatory trouble, 
and especially to the repair of the broken compensation. The most 
important result, however, of the new method lies in the strength- 
ening of the heart-muscle by gymnastic measures, in anemia, in atrophy 



DISEASES OF HEART AND BLOOD-VESSELS. 325 

of the heart, in uncompensated valvular lesions, in degeneration and 
fatty infiltration of the myocardium." 

The Oertel treatment, for its best application, needs peculiar cli- 
matic and topographic conditions — a certain elevation above the sea, 
a constant, moderate climate, hills or mountains, with good paths 
carefully laid in even and known gradients, and hotels under real 
medical control, with exact diet schedules correctly carried out. It 
is enough to mention these requirements for any one familiar with the 
climate and resorts of the United States to recognize at once that 
these conditions are not now met in any place in this country. 

The treatment is best carried out in a moderate elevation, 1,800 
to 2,200 feet, as the air is drier and purer at such a height. Ascents 
should carry the patient even higher than this — 3,000 to 3,500 feet 
or more. 

Exercise is as necessary to keep the heart-muscles in good condition 
as it is for any other set of muscles in the body. The first indication 
is met, therefore, by working the heart, by walking, by hill-climbing 
in a slightly rarefied atmosphere, and, if these do not suffice or are 
not available, by suitable gymnastics. Palpitation and breathlessness 
will naturally occur, but need cause no alarm unless very persistent. 
The patient should be told, if he suffers in this way, to stand still and 
breathe deeply. He should carry a stout stick and use it as a rest, 
thus fixing the shoulders and giving the chest muscles a point to 
work from. He should not sit down, as breathing is less free in this 
position than when erect. In two or three minutes at most he will be 
able to go on his way. 

As soon as exercise can be taken the patient should walk, on the 
flat or up-hill, according to his ability. It is to be remembered always 
that exertion, to have a good effect, must go to the povit of producing 
moderate fatigue. As the strength improves, the length of the walk 
and the height of the ascent should be made greater. In brief, exer- 
cise causes a determination of arterial blood to the skin, sweating 
accompanies this, the venous pressure, especially in the renal vessels, 
is lowered, the cardiac and pulmonary activity and the arterial pres- 
sure are increased. The anticipated effects should show themselves 
within a reasonable time — six or eight weeks. 

Compensation established by rest, and the dietetic matters regu- 
lated, we turn to exercise of the heart for the completion of the cure 
by permanent improvement in the cardiac power. The form of exer- 
cise must be one that can be measured with exactness, that will make 
no undue demands upon muscles as yet unable to respond to them, 
and yet will call sufficiently upon the heart and the breathing appa- 
ratus to produce the desired effect of strengthening them. 

Once compensation has been fully regained, the heart must be 
trained by graduated exercises to do as much work as it can without 



326 PRACTICAL HYDROTHERAPY. 

injury. Such work does not include sudden violent exertion, hard 
running, or the carrying of heavy weights. A person with a heart 
still weak from recent valvular disease, though competent for its work 
under ordinary conditions, should not attempt, for example, to run 
for a train. 

Enough has been said already in speaking of the two systems to 
indicate the manner in which cases should be selected for treatment. 
Patients with moderate degrees of incompetence, or with moderate 
dilatation, and those who suffer with functional tachycardia, need 
gentle, increasing, measured gymnastic exercise, combined, if possible, 
with some means which shall dilate peripheral vessels enough to lessen 
the heart's work in forcing the blood through them. Patients suffering 
from fatty infiltration, general obesity, respiratory insufficiency and 
consequent imperfect oxygenation, will have their requirements best 
met by long-continued moderate general exercise, of which the most 
desirable form is hill-climbing, sufficiently severe to make considerable 
demand upon the lungs, and, with this, there must be a dietetic regimen 
in which quantity and quality are adapted to individual needs, of 
curse, but generally of a character suited to those with a tendency 
to accumulate fat. 

The resistance movements already described form an excellent 
preparatory course, to which the hill-climbing is an invaluable sequel. 

Chronic Cardiac Disease; Organic Valvular Heart Disease; Mitral 
Regurgitation; Aortic Regurgitation; Tricuspid Regurgita- 
tion; Pulmonic Regurgitation; Mitral Stenosis; Aortic 
Stenosis; Tricuspid Stenosis; Pulmonic Stenosis; 
Chronic Myocarditis. 

These conditions represent insufficiency and obstruction to the 
normal flow of blood through the heart ; they are often associated 
together with, and most frequently have, endocarditis as their cause. 
Cardiac dilatation and hypertrophy may be present and frequently 
determine the treatment. In the early stages complete rest in bed 
is essential, and the treatment laid down for endocarditis may be 
followed. As the patient improves his life should be regulated and 
all nervous and mental strains, the extremes of passion, overwork and 
excitement avoided. The diet must be simple and given in small 
amounts, nutritious, easily digested, principally nitrogenized ; the 
thirst may be quenched with pure water in small amounts taken fre- 
quently. Carbonated water should be rather avoided or very small 
amounts allowed. Great care must be taken to avoid digestive dis- 
orders, especially gaseous distension, which impedes abdominal res- 
piration and venous circulation. Tea, coffee, condiments, alcohol and 
tobacco are to be forbidden. It is in these cases that the method here 
laid down has achieved some of its greatest results — that is to say, 



/& 



DISEASES OF HEART AND BLOOD-VESSELS. 327 

the carbon dioxide bath, commencing with a small quantity of saline 
and carbonic acid gas, a higher temperature and shorter duration, in 
connection with the exercises. We may follow the schedule of 
Saundby or commence with a simpler formula of sodium carbonate 
and commercial HC1; this is the writer's favorite method. At the 
end of a week or ten days we may add the Schott exercises, and 
finally finish with Oertel's method if necessary. Where palpitation 
exists apply the ice-bag, coil or cold compress over the heart. The 
writer has found massage, mechanical vibration and the static current 
of some value in the general treatment of these cases. Governed by 
conditions, he uses strychnine, digitalis, nitroglycerine, arsenic and iron. 
The foregoing treatment is based upon the first stage of the disease, 
but where it has progressed to the second, we may then institute the 
following schedule of treatment: If the heart is very weak, put the 
patient at perfect rest in bed, placing the ice-bag over the heart for 
fifteen minutes, gradually increased to thirty, two or three times daily. 
As soon as progress is made place the patient in the full dry pack for 
thirty minutes, followed by the cold sponge to the upper and lower 
extremities; do this for two clays, then twice daily for two days; 
then the full sponge twice daily at 70° F., followed by good friction. 
At this stage we can then apply the dripping sheet at 70° F. for one 
minute with vigorous friction ; increase one-half minute daily until 
three minutes is the duration. Each application is followed by the 
ice-bag to the heart for one hour. The Schott system of exercises 
may be used with these bed patients with much benefit, care being 
taken to never give the exercises within two hours of the hydriatic 
treatment. When the duration of the dripping sheet reaches three 
minutes, we may, in addition to the Schott exercises, order gentle, 
general massage, and as soon as the patient can possibly stand the 
treatment the carbon dioxide baths. These cases frequently suffer 
from insomnia, and for this the hot and cold spinal sponge or the 
Chapman's ice-bag to the spine for one hour may be instituted. Where 
there is kidney disease we should limit the amount of water-drinking 
to one or three pints daily ; apply the ice-bag over the heart and lower 
third of the sternum and the fomentation to the kidney. In the third 
stage complete rest should be enjoined, the dropsy treated and com- 
plications met as they arise. 

Cardiac Dilatation. 

This is an increase in the size of the heart, due to enlargement of 
one or more of its cavities. It is a failing heart, lacking in power 
and compensation, tending progressively to increase unless the cause 
is removed, and this fact should never be forgotten. Dyspnea, palpi- 
tation, "sinking," precordial discomfort, cyanosis and disturbances 
of the digestive and nervous systems usually mark its course. The 



328 PRACTICAL HYDROTHERAPY. 

pulse is frequent, irregular, of poor force, and its volume illy sus- 
tained. Its area upon percussion is increased, its apex impulse dimin- 
ished. Dilatation usually originates from rheumatism, the acute 
infectious diseases, influenza, nephritis, etc. In acute dilatation com- 
plete rest and the use of the ice-bag constitute the essential treatment. 
In this disease the condition is most suitably met by the use of the 
exercises and carbon dioxide baths, especially where the dilatation is 
due to weak muscle. All other methods that increase arterial tension 
and capillary resistance should be employed. Final improvement 
depends largely on the vigor, nutrition and natural resistance of the 
patients. 

Cardiac Hypertrophy. 

This is an increase in the size of the heart due to increased 
thickness of the heart walls. The left ventricle is more often affected 
because of the systemic work thrown upon it. There is usually little 
subjective disturbance, though there is a strong cardiac impact, in- 
crease in area of percussion, with an accentuated second sound. It 
originates from increased demands on the circulation, a compensatory 
process, in nephritis, valvular lesions, obstruction to pulmonary cir- 
culation, long-continued muscular exertion and free indulgence in 
spirits. These cases are likewise helped by the carbon dioxide bath 
and the Schott system of exercise. The incandescent electric light 
bath may be used, commencing with a small number of lights, grad- 
ually increased ; during its application apply the ice-bag to the pre- 
cordium. The after-treatment should be that of a very brief tonic 
measure. Strumpeil speaks highly of the value of the neutral bath 
at 90° to 93° F. for twenty to forty minutes daily, and the author 
can confirm his observation in this respect. Where the general cir- 
culation is much resistant, the nitrites should be administered in 
small doses. 

Fatty Heart. 

This embraces two distinct affections, fatty infiltration, in which 
there is an abnormal accumulation of fat on or about the surface of 
the organ and in the interstitial tissue, and fatty degeneration, the 
transformation of the cardiac muscular fiber into fat. They are 
usually the concomitants of general obesity. In infiltration the mus- 
cular fiber is weakened, tending toward dilatation. The obese fre- 
quently suffer with slight intermittence of the pulse, feeble apex 
beat and some enlarged area of dullness. It is more common in those 
who lead a sedentary life and occupation ; certain races are predis- 
posed to it. Heredity, age, sex, the ingestion of beer, sweets, 
starches and excessive indulgence at the table are among the commoner 
conditions that are found. Dilatation of the heart may frequently 
supervene unless treatment is undertaken. In the management of 



s~ 



DISEASES OF HEART AND BLOOD-VESSELS. 329 

these cases we should follow along the lines laid down for the treat- 
ment of obesity, in connection with the Schott method. It is an 
excellent idea to commence with the Schott system of baths and 
exercises supplemented by massage and later place the patient upon 
Oertel's method, which is especially valuable after the above course 
of treatment and which was really originated for the management of 
fatty hearts. The author has had considerable experience in the 
management of these cases and feels that where the treatment is early 
taken in hand relief and "cure" may be promised. Patients are 
prone as a rule to be careless with their exercise and diet during the 
time they are from under the supervision of the physician, and for 
that reason we should insist upon their following out a rigid "course" 
of treatment of five or six weeks' time each year. It is most difficult 
to convince them of the necessity of so doing. 

Arterio-Sclerosis ; Hypertension. 

Arterio-fibrosis is a thickening of the walls of the arteries due to 
morbid changes in the intima, giving rise to a localized or general 
narrowing of the caliber or lumen of the vessel. Hypertension may 
exist independently of arterio-sclerosis but is indicative of a tendency 
toward vascular thickening. In true arterio-sclerosis the vessel wall 
is hard, the heart is hypertrophied ; its second sound accentuated and 
snappy ; the peripheral resistance increased. Cardiac dilatation may 
follow this condition. Dyspnea, palpitation, headache, vertigo, palsies, 
arcus senilis usually accompany the disease. It occurs most frequently 
in old age or in the middle aged, although I have seen the condition 
in patients under thirty. Heredity, alcohol, rheumatism, gout, malaria, 
syphilis, overwork and overeating tend to produce the trouble. These 
cases must lead a quiet, well regulated life, free from anxieties and 
worry, avoid excess in eating, use no alcoholic spirits and take courses 
of the nitrites and nitroglycerine. The diet should be simple. 

Dietary change must not be too rapidly made', but its gradual 
regulation and change may be made within three to six months. No 
revolution is needed but a common sense method of limiting both the 
quantity and quality. These patients should avoid fluids with ordinary 
hearty meals, giving up soups, especially meat soups, and confining 
the use of all fluids to four or six ounces at a meal. In proper cases 
permit fluids between meals. When digested, milk is best of all. 
Increase vegetables and diminish meats. Use white meats, save in 
those of anemic tendencies, when red meat may occasionally be 
needed. Substitute digestible fish for even some white meat. Exclude 
game, save fresh white game. Discard sweets and starchy desserts, 
overseasoning, spices, and condiments. Contrary to the general idea, 
very moderate quantities of water should be drunk ; this tends to in- 
crease the tension and do damage to the already overworked kidney 



330 PRACTICAL HYDROTHERAPY. 

(see Chronic Nephritis) unless severe toxemia is present. Trinecek 
has advocated the moderate use of water so "mineralized" as to re- 
semble the plasma, containing as it does certain inorganic salts. Each 
250 c.c. of water is to contain sodium sulphate 0.008, sodium chloride 
0.1, sodium phosphate 0.003, sodium carbonate 0.005, potassium 
sulphate 0.008. 

In the very early stages of the disease and in those who are 
vigorous we may commence the cautious use of hydrotherapy by 
administering the full dry pack followed by a rapid cold sponge, care 
being taken to keep the head cool. As soon as we have tested the 
reaction of the patient we may administer the electric light bath until 
perspiration takes place followed by the horizontal rain bath at 100° 
to 105° F. for one and one-half minutes reduced at first to 80° F. 
for one-fourth minute; pressure twenty pounds. Cautiously reduce 
the temperature one degree daily, studying the reactive capacity of 
the patient. Huchard 3 says that he has found the low-pressure neutral 
jet douche at 92° to 96° F., applied to either side of the spinal column 
for three to eight minutes, a powerful nerve sedative and circulatory 
help. He gradually passes to the neutral horizontal rain or circular 
needle bath for one to two minutes, gradually reduced to the point 
of pleasant coolness, this to be regulated by the patient. I can un- 
questionably substantiate his experience and statement that "heart 
disease and other pathologic conditions of heart weakness are very 
often dependent not only upon the heart itself and its innervation, but 
also upon peripheral innervation, and that when sedation occurs the 
general disturbance improves or ceases." Hirschfeld believes that 
where they can be borne the hot full bath is an excellent home method ; 
the skin becomes vascular, relieves the internal organs, lifts the load, 
relieves insomnia, increases metabolism and oxidation, eliminates 
waste materials and increases the vascular "habit" of the cutis. In 
most cases it is best to commence with the carbon dioxide bath, grad- 
ually increasing its strength as the patient responds. This method is 
especially valuable where we have a concomitant cardiac dilatation, 
as it strengthens the heart muscle. 

Regarding the use of baths and gymnastics in arterio-sclerosis, 
J. Groedel, of Bad-Nauheim, who has given special attention to the 
treatment of arterio-sclerosis, contends that, although the increased 
blood-pressure, "considered as the usual consequence of treatment by 
the Nauheim baths, may, at first sight, seem to indicate that every 
patient with arterio-sclerosis should be excluded from a treatment by 
baths, a further increase of the high blood-pressure usually found in 
arterio-scleorsis must not only surcharge the heart more than is already 
the case, but also create the danger of the bursting of a cerebral 
aneurism, so often present in cases of arterio-sclerosis." He has by 

3 Huchard, M. : Blatter f. klinische Hydrotherapie, 1904. 



DISEASES OF HEART AND BLOOD-VESSELS. 331 

numerous observations been able to convince himself that baths can 
be prescribed for these patients "in such a manner that the increase 
of blood-pressure does not take place, or only in a very slight degree." 
If the temperature be kept almost at the point of "indifference" — 
that is, about 92° to 93° F. (33.2° to 33.8° C.)— the primary acute 
increase of blood-pressure caused by the contraction of the cutaneous 
vessels, and most to be feared, will be very slight, and if there be 
carbonic acid in the bath it will at the same time quickly disappear. 
If the skin of the patient be cooled somewhat by moistening the parts 
particularly sensitive to cold before entering the bath, the avoidance 
of that primary increase of blood-pressure, or, indeed, any shock 
whatever, will be the more certain. A similarly good effect is pro- 
duced when the patient is only allowed to take half baths and the 
exposed parts of the body are wrapped up so as to prevent cooling. 
In most cases the amount of water can be increased little by little at 
each bath until a full bath is at length attained, but even then it is 
advisable to let the patient only submerge his body by degrees. 
Placing cold bandages on the bather's head is often indicated. By 
proceeding cautiously in this manner he has never had an unfortunate 
case in the course of a practice of twenty-two years in Nauheim. 
Under what conditions is a course of baths indicated or beneficial in 
cases of arterio-sclerosis ? It is mostly a question of diseases based 
on the same etiological principle as arterio-sclerosis itself, or such as 
usually lead to it. By combating these we can at the same time retard 
the progress of the sclerotic process in the vessels. 

Angina Pectoris. 

Angina pectoris is dependent upon organic disease of the heart 
or aorta. It is of sudden onset, with agonizing pain in the sternal 
region, a sense of constriction and impending death. The pain 
radiates to the back, shoulders and arm, especially the left. During 
the attack the patient is pale, motionless, haggard ; the cold sweat 
stands upon the brow ; sits or stands immobile. The attack may 
prove suddenly fatal or occur at irregular intervals. It is frequently 
found associated with other diseases — arterio-sclerosis, cardiac hyper- 
trophy or dilatation, aortic regurgitation and feebleness of muscular 
power. It occurs usually after forty years of age, and is most fre- 
quent in males. Causative factors to be looked for are alcohol, 
syphilis, rheumatism, gout, diabetes, nephritis and la grippe. The 
attacks are often precipitated by over-exertion, worry and digestive 
disorders. There is usually sclerosis of the coronary arteries. 
Da Costa says that "hardly an affection of the walls or cavity of the 
heart, scarcely a morbid condition of the arteries that nourish it or 
spring from it, with which the distressing malady has not been ob- 
served to be associated." In most cases we find a large neural 



332 PRACTICAL HYDROTHERAPY. 

element, toxic irritation, high tension or arterio-sclerosis. Schott 
believes it to be due to a further reduction of the muscular energy 
of an already enfeebled heart muscle, accompanied by pathologic 
sclerosis of the coronary vessels, plus the resistance ot a contracted 
arterial system. It is a dangerous malady, but life may be prolonged 
for years. During the attack nitrite of amyl or nitroglycerine should 
be immediately administered, the patient placed in a recumbent 
position, friction applied to the limbs, and if the heart is beating 
weakly an ice-bag over the precordium. In the general management 
of the case we should forbid all stimulants, tobacco and coffee. The 
life should be regular and free from worry, the diet simple, the fluids 
restricted. The presence of arterio-sclerosis must be constantly borne 
in mind and proper treatment instituted. In these cases the full 
method of the carbon dioxide bath and the Schott system of exercise 
should be instituted, carefully graduated to suit the individual case, 
but most persistently and systematically followed out. The course 
of treatment is to be given for some months, depending on the case; 
time is allowed to intervene and another course instituted. These 
patients purchase existence, and even life itself, only by the care and 
attention with which they follow out instructions and take their 
courses of treatment. During the non-treatment interim the patient 
should take small doses of some nitrite and use the Chapman's ice- 
bag applied over the fourth dorsal to the third lumbar spinal segment 
once or twice daily for forty minutes. The writer has seen some 
good, he believes, come from the application of the galvanic current 
to the vagus in the neck and from the use of the static wave 
current. Some cases seem to do best upon nitrite of soda, two to 
five grains four times daily ; others better upon erythroltetranitrate, 
grains one, three to four times daily. 

Functional Heart Disease; Cardiac Neuroses; Cardiac Collapse; 

Neurasthenic or Weak Heart; Palpitation; Brachycardia ; 

Tachycardia ; Arhythmia. 

The functional disorders of the heart are grouped together, as 
the general treatment of these conditions is similar and the author 
does not care to repeat needlessly treatment for separate states where 
they can be grouped. Certain forms of them require a few special 
applications, and these will be duly noted. 

Palpitation is an undue and rapid heart action, the frequency of 
the beats being sufficient to cause discomfort, usually accompanied 
by more or less irregularity of rhythm. The heart becomes tumultu- 
ous. There is a sensation of precordial discomfort, violent beat 
against chest, face pale. It most frequently occurs from some sudden 
scare, nervous strain or excitement, and usually disappears after the 
cause is removed. It is more frequent in females than in males. It 



DISEASES OF HEART AND BLOOD-VESSELS. 333 

is also caused by anxieties, business responsibilities and worries, fear, 
emotion, anemia, digestive disorders, neurasthenia, excessive tobacco, 
etc. Physical examination shows a negative cardiac condition, and 
for that reason care should be taken to seek for the causal factors 
underlying the trouble and remove them. 

Tachycardia is an abnormal rapid heart whose action is regular, 
unattended by other symptoms; perfect general and cardiac health 
may exist with this disorder present. We may have paroxysmal 
attacks due to fright and emotion, the pulse being so rapid, thin and 
compressible as to be uncountable. Care should be taken, however, 
to carefully seek for factors that produce tachycardia, especially the 
forms • of exopthalmic goiter. The condition is probably due, as 
Woods says, to a lesion of the accelerator of the heart. Where 
exopthalmic goiter exists this disease 'should be treated, as the cardiac 
condition forms but a part of the symptom-complex. In all cases 
the digestive condition should be investigated, and if necessary lavage 
practiced and intragastric faradization used. In these diseases the 
ice-bag over the precordium is especially valuable, as it diminishes 
the number of cardiac pulsations, increases the systolic force by 
acting directly on the myocardium, increases blood pressure and 
respiration. 

Neurasthenia, or weak feeble heart, demands no special treatment 
other than that embraced in the treatment of neurasthenia itself, to 
which section the reader is referred. 

Arhythmia is a condition accompanied by cardiac irregularity both 
as to the time and power of the heart beat. The heart may intermit 
and miss a beat, a feeling that is very disagreeable to most cases. 
Many forms of the trouble exist — Trawles' pulsus alternans, in which 
one pulse is normal, the next feeble; Kussmaul's pulsus paradoxus, 
in which the heart beats more frequently, but weaker during the 
inspiration than expiration, this condition having been most frequently 
observed in pericarditis ; pulsus bigeminus, or the double pulse — that 
is to say, a pulse in which we have two successive rapid beats, then 
two successive slower beats, most frequently found in mitral disease; 
delirium cordis, in which all these conditions may be present. These 
variations from the normal may exist in apparently well individuals, 
but, generally speaking, some disease is more or less present. Im- 
mediate relief and comfort may be secured